Healthcare Provider Details

I. General information

NPI: 1871673038
Provider Name (Legal Business Name): ERNESTO GERARDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/17/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E ROYALTON RD STE 2100
BROADVIEW HEIGHTS OH
44147-3532
US

IV. Provider business mailing address

PO BOX 901599
CLEVELAND OH
44190-1599
US

V. Phone/Fax

Practice location:
  • Phone: 440-526-8222
  • Fax: 440-526-7881
Mailing address:
  • Phone: 440-526-8222
  • Fax: 440-526-7881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35049474G
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: