Provider Demographics
NPI:1740176007
Name:BETCHEM, GERVAI
Entity type:Individual
Prefix:
First Name:GERVAI
Middle Name:
Last Name:BETCHEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 APPLETON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-1133
Mailing Address - Country:US
Mailing Address - Phone:240-316-7513
Mailing Address - Fax:240-316-7513
Practice Address - Street 1:1713 APPLETON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1133
Practice Address - Country:US
Practice Address - Phone:240-316-7513
Practice Address - Fax:240-316-7513
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator