Provider Demographics
NPI:1760554182
Name:GERST, PAUL ANDREW (LAC CPM)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ANDREW
Last Name:GERST
Suffix:
Gender:M
Credentials:LAC CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 LONG POND RD
Mailing Address - Street 2:STE 111
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2642
Mailing Address - Country:US
Mailing Address - Phone:774-283-2726
Mailing Address - Fax:
Practice Address - Street 1:110 LONG POND RD
Practice Address - Street 2:STE 111
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2642
Practice Address - Country:US
Practice Address - Phone:774-283-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI235-055171100000X
MA241993171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist