MEDICARE: THERESA Y GERLACH CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	0024112462	VA

General Provider Information

NPI Number	:	1023285764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA Y GERLACH CRNA

Provider Business Mailing Address
First Line	:	PO BOX 71230
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19176-6230
Country	:	US
Telephone Number	:	703-383-6469
Fax Number	:

Provider Business Practice Location Address
First Line	:	13350 FRANKLIN FARM RD
Second Line	:	SUITE 100
City	:	HERNDON
State	:	VA
Zip	:	20171-4091
Country	:	US
Telephone Number	:	703-334-1010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	01/24/2012

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