Provider Demographics
NPI:1760487441
Name:GERRY, SCOTT W (D P M)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:GERRY
Suffix:
Gender:M
Credentials:D P M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-0736
Mailing Address - Country:US
Mailing Address - Phone:603-994-7633
Mailing Address - Fax:603-994-7648
Practice Address - Street 1:21 WHITEHALL RD STE 302
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3236
Practice Address - Country:US
Practice Address - Phone:603-994-7633
Practice Address - Fax:603-994-7648
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD190213E00000X
MEPOD 190213ES0103X
MA1842213ES0103X
NH0193213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30003216Medicaid
ME195460000Medicaid
VA620707Other620707
MA0362182Medicaid
ME037709OtherANTHEM
ME2704007OtherUNITED HEALTHCARE
ME2292640OtherAETNA
NH03Y005316ME01OtherANTHEM
ME1760487441OtherNPI #
ME22122OtherCIGNA
MEE002988OtherTRICARE
ME1942309737OtherGROUP NPI #
MEMGH549OtherHARVARD PILGRIM
ME043364985OtherTAX ID#
MAY70850Medicare ID - Type Unspecified
VA620707Other620707