Provider Demographics
NPI:1306875513
Name:GERLACH, DETLEF HORST (MD)
Entity type:Individual
Prefix:DR
First Name:DETLEF
Middle Name:HORST
Last Name:GERLACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:1399 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3840
Practice Address - Country:US
Practice Address - Phone:717-812-2316
Practice Address - Fax:717-812-2165
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021900E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0068413000OtherAMERIHEALTH 65 PA
PA020424OtherJOHNS HOPKINS
PA533254OtherMAMSI-WMG
PA4296808OtherAETNA
PA81672OtherUNISON-WMG
MD525990OtherCAREFIRST MD BCBS
PA1503626OtherGATEWAY-WMG
PA38918OtherGEISINGER
PA093807OtherHIGHMARK BLUE SHIELD
PA01530702OtherCAPITAL BLUE CROSS-WMG
PA1117732OtherAMERIHEALTH MERCY-WMG
PA1117732OtherAMERIHEALTH MERCY-WMG
PAB36010Medicare UPIN
PA093807FLTMedicare PIN