Provider Demographics
NPI:1871673038
Name:GERARDO, ERNESTO (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:GERARDO
Suffix:
Gender:M
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:PO BOX 901599
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44190-1599
Mailing Address - Country:US
Mailing Address - Phone:440-526-8222
Mailing Address - Fax:440-526-7881
Practice Address - Street 1:5901 E ROYALTON RD STE 2100
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-3532
Practice Address - Country:US
Practice Address - Phone:440-526-8222
Practice Address - Fax:440-526-7881
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049474G208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics