Healthcare Provider Details

I. General information

NPI: 1134473168
Provider Name (Legal Business Name): STEVEN MARC GEMMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 COLLINS AVE
MARYSVILLE OH
43040-8808
US

IV. Provider business mailing address

4932 GALWAY DR
DUBLIN OH
43017-8410
US

V. Phone/Fax

Practice location:
  • Phone: 937-642-1065
  • Fax:
Mailing address:
  • Phone: 614-530-5789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35058719
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: