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General NPI Number Information
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NPI Number | 1093995938
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Entity Type | Organization
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Legal Business Name | ROY W GERNHARDT III MD PC
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 1732 WYOMING AVE
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City | FORTY FORT
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State | PA
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Zip | 18704-4340
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Country | US
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Telephone | 570-288-6888
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Fax | 570-288-6880
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Provider Business Mailing Address
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Address Line | 415 N MAIN ST
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City | WILKES BARRE
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State | PA
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Zip | 18702-4411
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Country | US
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Telephone | 570-208-5571
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Fax | 570-208-5548
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ROY W GERNHARDT
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Credential | MD
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Telephone | 570-288-6888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD432211
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License Number State | PA
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