Provider Demographics
NPI:1881612513
Name:O'GRADY, GERALD PATRICK (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:PATRICK
Last Name:O'GRADY
Suffix:
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 1:1505 SOQUEL DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1716
Mailing Address - Country:US
Mailing Address - Phone:831-462-2111
Mailing Address - Fax:831-462-1411
Practice Address - Street 1:1505 SOQUEL DR
Practice Address - Street 2:SUITE 7
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1716
Practice Address - Country:US
Practice Address - Phone:831-462-2111
Practice Address - Fax:831-462-1411
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAG31655207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44831Medicare UPIN
CA00G316550Medicare PIN