Healthcare Provider Details

I. General information

NPI: 1386915080
Provider Name (Legal Business Name): RICHARD JAMES GERLACH MA, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 LEONARD AVE
FAIRMONT WV
26554-3843
US

IV. Provider business mailing address

6204 STONEWOOD DR
MORGANTOWN WV
26505-3871
US

V. Phone/Fax

Practice location:
  • Phone: 304-296-1731
  • Fax:
Mailing address:
  • Phone: 215-740-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: