Provider Demographics
NPI:1265874267
Name:WASKO, GERALD L JR (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:L
Last Name:WASKO
Suffix:JR
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 1:330 WICK AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44503-1002
Mailing Address - Country:US
Mailing Address - Phone:330-941-3489
Mailing Address - Fax:330-941-3186
Practice Address - Street 1:330 WICK AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44503-1002
Practice Address - Country:US
Practice Address - Phone:330-747-4660
Practice Address - Fax:330-747-4661
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0177005Medicaid