Healthcare Provider Details

I. General information

NPI: 1811167059
Provider Name (Legal Business Name): CARLA B GERSTENBERG DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 SILVER BLUFF RD SUITE 2
AIKEN SC
29803-6012
US

IV. Provider business mailing address

598 SILVER BLUFF RD SUITE 2
AIKEN SC
29803-6012
US

V. Phone/Fax

Practice location:
  • Phone: 803-649-2934
  • Fax: 803-649-2902
Mailing address:
  • Phone: 803-649-2934
  • Fax: 803-649-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA L LANE
Title or Position: BILLING CODING SPECIALIST
Credential:
Phone: 803-649-2934