Provider Demographics
NPI:1215947411
Name:GERSH, HARVEY ALLEN (MD)
Entity type:Individual
Prefix:
First Name:HARVEY
Middle Name:ALLEN
Last Name:GERSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W CANEBRAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8341
Mailing Address - Country:US
Mailing Address - Phone:601-261-0315
Mailing Address - Fax:
Practice Address - Street 1:117 W CANEBRAKE BLVD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8341
Practice Address - Country:US
Practice Address - Phone:601-261-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07885207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1559195OtherAMERICAN ADMIN GROUP
LA1198943Medicaid
MS00016243Medicaid
408113450OtherRAILROAD MEDICARE
AL009604730Medicaid
MS391945167Medicare PIN
408113450OtherRAILROAD MEDICARE