Provider Demographics
NPI:1982020269
Name:CAROL A. GERDES M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CAROL A. GERDES M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GERDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-864-0660
Mailing Address - Street 1:501 S SHORE CTR W
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5762
Mailing Address - Country:US
Mailing Address - Phone:510-864-0660
Mailing Address - Fax:510-864-0393
Practice Address - Street 1:501 S SHORE CTR W
Practice Address - Street 2:SUITE D
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5762
Practice Address - Country:US
Practice Address - Phone:510-864-0660
Practice Address - Fax:510-864-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62236207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G622360Medicaid
1417063306Medicare PIN
CA00G622360Medicaid