MEDICARE: AMANDA HAIMAN GERSICH 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	208000000X	Pediatrics Physician	A066013	CA
2	174H00000X	Health Educator

General Provider Information

NPI Number	:	1467539460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA HAIMAN GERSICH M.D.

Provider Business Mailing Address
First Line	:	1885 BAY RD
Second Line	:
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-1312
Country	:	US
Telephone Number	:	650-330-7400
Fax Number	:	650-321-1156

Provider Business Practice Location Address
First Line	:	1885 BAY RD
Second Line	:
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-1312
Country	:	US
Telephone Number	:	650-330-7400
Fax Number	:	650-321-1156

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/07/2022

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