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General NPI Number Information
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NPI Number | 1588696058
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Entity Type | Individual
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Provider Name | CONSTANCE S GERASSIMAKIS MD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 119 CASSINA DR
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City | MIDDLETOWN
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State | DE
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Zip | 19709-9184
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Country | US
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Telephone | 302-378-6017
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Fax |
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Provider Business Mailing Address
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Address Line | 119 CASSINA DR
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City | MIDDLETOWN
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State | DE
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Zip | 19709-9184
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Country | US
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Telephone | 302-378-6017
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35-067475
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | D0065586
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 35.067475
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C1-0003051
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License Number State | DE
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