Provider Demographics
NPI:1386915080
Name:GERLACH, RICHARD JAMES (MA, NCC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JAMES
Last Name:GERLACH
Suffix:
Gender:M
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3871
Mailing Address - Country:US
Mailing Address - Phone:215-740-2208
Mailing Address - Fax:
Practice Address - Street 1:448 LEONARD AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3843
Practice Address - Country:US
Practice Address - Phone:304-296-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker