Provider Demographics
NPI:1811647696
Name:GERCKEN, CORINNE ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:ROSE
Last Name:GERCKEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MACBETH CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-1573
Mailing Address - Country:US
Mailing Address - Phone:443-866-2556
Mailing Address - Fax:
Practice Address - Street 1:400 FAYETTE ST STE 180
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2186
Practice Address - Country:US
Practice Address - Phone:833-348-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant