Healthcare Provider Details

I. General information

NPI: 1275519704
Provider Name (Legal Business Name): GERALD D VERDI DDS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 DUTCHMANS LN STE 311
LOUISVILLE KY
40207-4707
US

IV. Provider business mailing address

4121 DUTCHMANS LN STE 311
LOUISVILLE KY
40207-4707
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-5555
  • Fax: 502-895-5550
Mailing address:
  • Phone: 502-895-5555
  • Fax: 502-895-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number16645
License Number StateKY

VIII. Authorized Official

Name: DR. GERALD D VERDI
Title or Position: OWNER / PHYSICIAN
Credential: DDS MD
Phone: 502-895-5555