Healthcare Provider Details

I. General information

NPI: 1326041518
Provider Name (Legal Business Name): KEVIN B GEROLD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVENUE A3W-387 DEPARTMENT OF ANESTHESIOLOGY, JHBMC
BALTIMORE MD
21224-2780
US

IV. Provider business mailing address

1212 HART RD
TOWSON MD
21286-1632
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-4557
  • Fax: 410-550-0443
Mailing address:
  • Phone: 410-583-9848
  • Fax: 410-583-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberH31298
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberH31298
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberH31298
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: