Provider Demographics
NPI:1689791097
Name:MEHALICK, GERALD THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:THOMAS
Last Name:MEHALICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WEST 10TH ST
Mailing Address - Street 2:CONNECTIONS COMMUNITY SUPPORT PROGRAMS, INC.
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801
Mailing Address - Country:US
Mailing Address - Phone:610-544-5485
Mailing Address - Fax:
Practice Address - Street 1:500 WEST 10TH ST
Practice Address - Street 2:CONNECTIONS COMMUNITY SUPPORT PROGRAMS, INC.
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801
Practice Address - Country:US
Practice Address - Phone:302-328-3330
Practice Address - Fax:302-328-9336
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-00058372084A0401X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC2-0005837OtherPROFESSIONAL LICENSE
DEC2-0005837OtherPROFESSIONAL LICENSE
DEC2-0005837OtherPROFESSIONAL LICENSE