Provider Demographics
NPI:1134385107
Name:GERHARDT, WINIFRED B (PA)
Entity type:Individual
Prefix:
First Name:WINIFRED
Middle Name:B
Last Name:GERHARDT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2218
Mailing Address - Country:US
Mailing Address - Phone:978-468-7381
Mailing Address - Fax:978-468-6020
Practice Address - Street 1:15 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-2218
Practice Address - Country:US
Practice Address - Phone:978-468-7381
Practice Address - Fax:978-468-6020
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA982363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical