Healthcare Provider Details

I. General information

NPI: 1508829490
Provider Name (Legal Business Name): ZACHARIAH GERGER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 VAIL AVE
CHARLOTTE NC
28207-1219
US

IV. Provider business mailing address

PO BOX 36351
CHARLOTTE NC
28236-6351
US

V. Phone/Fax

Practice location:
  • Phone: 704-379-5359
  • Fax: 704-379-5364
Mailing address:
  • Phone: 704-377-5772
  • Fax: 704-377-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number96-01614
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: