MEDICARE: DR. MARK ANDREW GERSMAN M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0107X	Retina Specialist (Ophthalmology) Physician	35.060285	OH
2	207W00000X	Ophthalmology Physician	35060285	OH
3	207W00000X	Ophthalmology Physician	18631	WV
4	207W00000X	Ophthalmology Physician	MD057570L	PA
5	207WX0107X	Retina Specialist (Ophthalmology) Physician	MD057570L	PA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4036611	OTHER	OH	MCR # OTHER TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	180041827	OTHER	OH	RRMCR # OTHER TAX ID
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1205839552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ANDREW GERSMAN M.D.

Provider Business Mailing Address
First Line	:	4676 DOUGLAS CIR NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-3619
Country	:	US
Telephone Number	:	330-494-1116
Fax Number	:	330-494-0276

Provider Business Practice Location Address
First Line	:	4676 DOUGLAS CIR NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-3619
Country	:	US
Telephone Number	:	330-494-1116
Fax Number	:	330-494-0276

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	05/24/2021

2050 CUMMING HWY , SUITE 100
CANTON, GA
30114-8614

Practice Phone: 770-345-9600
Practice Fax: