Provider Demographics
NPI:1013929132
Name:GERSAPPE, ANAND ASHOK (MD, PHD)
Entity Type:Individual
Prefix:MR
First Name:ANAND
Middle Name:ASHOK
Last Name:GERSAPPE
Suffix:
Gender:M
Credentials:MD, PHD
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 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:550 17TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5788
Practice Address - Country:US
Practice Address - Phone:206-386-4744
Practice Address - Fax:206-215-1135
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60142525207RS0012X, 2084S0012X
NY2297512084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000528226003OtherBCBS OF WNY
NY000528226001OtherBCBS OF WNY
NY000528226002OtherBCBS OF WNY
NY000528226004OtherBCBS OF WNY
NY00027478301OtherUNIVERA HEALTHCARE
NY161598214OtherTAX IDENTIFICATION NUMBER
NY0512877OtherINDEPENDENT HEALTH
NY00027478301OtherUNIVERA HEALTHCARE
NY000528226004OtherBCBS OF WNY
NYRA7801Medicare UPIN