MEDICARE: KENNETH W GERARD M.D.

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	207L00000X	Anesthesiology Physician	C1-0003259	DE
2	207L00000X	Anesthesiology Physician	ME96504	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56538	OTHER	FL	BCBSFL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336172154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH W GERARD M.D.

Provider Business Mailing Address
First Line	:	11781 LEE JACKSON MEMORIAL HWY
Second Line	:	STE 550
City	:	FAIRFAX
State	:	VA
Zip	:	22033-3309
Country	:	US
Telephone Number	:	571-777-5106
Fax Number	:	703-563-6256

Provider Business Practice Location Address
First Line	:	7915 LAKE MANASSAS DR
Second Line	:	STE 302
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3260
Country	:	US
Telephone Number	:	571-248-0653
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	12/04/2015

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Directions to “ KENNETH W GERARD M.D.” Practice Location

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