Provider Demographics
NPI:1679578652
Name:GERHARDT, EDWARD B (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:B
Last Name:GERHARDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-3200
Mailing Address - Fax:336-832-3201
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1230
Practice Address - Country:US
Practice Address - Phone:336-832-3200
Practice Address - Fax:336-832-3201
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33513208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1800535OtherUHC
NC35476OtherMEDCOST
NC8935134Medicaid
NC330003710OtherRR MCR
NC35134OtherBCBS
NC8935134Medicaid
NC213849Medicare PIN