MEDICARE: MR. MARK H GERSTEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	35058857	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003929555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK H GERSTEN MD

Provider Business Mailing Address
First Line	:	20800 HARVARD RD
Second Line	:	2ND FLR
City	:	HIGHLAND HILLS
State	:	OH
Zip	:	44122-7251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3909 ORANGE PL
Second Line	:	STE 2100
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4478
Country	:	US
Telephone Number	:	216-896-1800
Fax Number	:	216-896-1801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	03/02/2016

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