Provider Demographics
NPI:1942313176
Name:GERSH, STEVEN ARNOLD (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ARNOLD
Last Name:GERSH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 WILKENS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4848
Mailing Address - Country:US
Mailing Address - Phone:410-242-7066
Mailing Address - Fax:410-242-4126
Practice Address - Street 1:8556 FORT SMALLWOOD ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122
Practice Address - Country:US
Practice Address - Phone:410-255-1190
Practice Address - Fax:410-255-1484
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01089213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK925GI52295805OtherBLUE SHIELD
MDS128GI52295804OtherBLUE SHIELD
MDKM89GI52295802OtherBLUE SHIELD
DC30650003OtherBLUE SHIELD DC
DC30650003OtherBLUE SHIELD DC
MDK925GR13Medicare ID - Type Unspecified
MDKM89JX49Medicare ID - Type Unspecified
MDS128AK33Medicare ID - Type Unspecified
MD0470210004Medicare NSC
MD0470210003Medicare NSC