Provider Demographics
NPI:1801024070
Name:GERACE, GRETCHEN V (MD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:V
Last Name:GERACE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:216-381-2223
Mailing Address - Fax:216-381-5975
Practice Address - Street 1:1611 S GREEN RD STE 216
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4123
Practice Address - Country:US
Practice Address - Phone:216-381-2223
Practice Address - Fax:216-381-5975
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35-120843207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0749631Medicaid