=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174634455
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLERGY & ASTHMA ASSOCIATES, P. S. C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 171 N EAGLE CREEK DR STE 106
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40509-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-277-9112
-----------------------------------------------------
Fax | 859-277-7105
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 171 N EAGLE CREEK DR STE 106
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40509-1801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-277-9112
-----------------------------------------------------
Fax | 859-277-7105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KENNETH L GERSON
-----------------------------------------------------
Credential | M. D.
-----------------------------------------------------
Telephone | 859-277-9112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 174400000X
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------