Provider Demographics
NPI:1891771614
Name:GERSCOVICH, EUGENIO (MD)
Entity Type:Individual
Prefix:
First Name:EUGENIO
Middle Name:
Last Name:GERSCOVICH
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 1:4860 Y ST
Mailing Address - Street 2:SUITE 3100 ACC
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-3606
Mailing Address - Fax:916-734-8490
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 3100 ACC
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-3606
Practice Address - Fax:916-734-8490
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA298572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A298570Medicare PIN
A25891Medicare UPIN