MEDICARE: SCOTT W GERRY D. P. M.

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	213E00000X	Podiatrist	POD190	ME
2	213ES0103X	Foot & Ankle Surgery Podiatrist	POD 190	ME
3	213ES0103X	Foot & Ankle Surgery Podiatrist	1842	MA
4	213ES0103X	Foot & Ankle Surgery Podiatrist	0193	NH

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	620707	OTHER	VA	620707
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	037709	OTHER	ME	ANTHEM
6	2704007	OTHER	ME	UNITED HEALTHCARE
7	2292640	OTHER	ME	AETNA
8	03Y005316ME01	OTHER	NH	ANTHEM
9	1760487441	OTHER	ME	NPI #
10	22122	OTHER	ME	CIGNA
11	E002988	OTHER	ME	TRICARE
12	1942309737	OTHER	ME	GROUP NPI #
13	MGH549	OTHER	ME	HARVARD PILGRIM
14	043364985	OTHER	ME	TAX ID#

General Provider Information

NPI Number	:	1760487441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT W GERRY D. P. M.

Provider Business Mailing Address
First Line	:	PO BOX 736
Second Line	:
City	:	SPRINGVALE
State	:	ME
Zip	:	04083-0736
Country	:	US
Telephone Number	:	603-994-7633
Fax Number	:	603-994-7648

Provider Business Practice Location Address
First Line	:	21 WHITEHALL RD STE 302
Second Line	:
City	:	ROCHESTER
State	:	NH
Zip	:	03867-3236
Country	:	US
Telephone Number	:	603-994-7633
Fax Number	:	603-994-7648

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	03/09/2022

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