Provider Demographics
NPI:1154389096
Name:GERHARDT, CAROLINE A (MD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:A
Last Name:GERHARDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2618
Mailing Address - Country:US
Mailing Address - Phone:603-448-1941
Mailing Address - Fax:603-448-6059
Practice Address - Street 1:252 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2618
Practice Address - Country:US
Practice Address - Phone:603-448-1941
Practice Address - Fax:603-448-6059
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH23338207Q00000X
MDD0060595207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402523700Medicaid
9960OtherCAREFIRST
9960OtherCAREFIRST
MD012277E14Medicare ID - Type Unspecified
H89382Medicare UPIN