Provider Demographics
NPI:1073519393
Name:GERADTS, JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:GERADTS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 THAMES DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7185
Mailing Address - Country:US
Mailing Address - Phone:919-943-3371
Mailing Address - Fax:
Practice Address - Street 1:600 MOYE BLVD.
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY, ECU HEALTH MEDICAL CENTER
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2350
Practice Address - Country:US
Practice Address - Phone:919-943-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265672207ZP0101X
CAG65531207ZP0101X
NC9300702207ZP0102X
NY221876207ZP0102X
NC93-00702207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02166347Medicaid
NY02166347Medicaid
NC2192512AMedicare PIN