Provider Demographics
NPI:1851379630
Name:GERSTEIN, DEBRA SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUSAN
Last Name:GERSTEIN
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 1:1569 BEACON ST
Mailing Address - Street 2:APT 31
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4612
Mailing Address - Country:US
Mailing Address - Phone:617-277-5583
Mailing Address - Fax:
Practice Address - Street 1:50 NORTH ST
Practice Address - Street 2:FAMILY PRACTICE ASSOCIATES
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-1654
Practice Address - Country:US
Practice Address - Phone:508-359-1519
Practice Address - Fax:508-359-4345
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2000903Medicaid
H77090Medicare UPIN
MAA34965Medicare ID - Type Unspecified