Provider Demographics
NPI:1396799318
Name:GEHRKEN, GEORGE ANDREW JR (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ANDREW
Last Name:GEHRKEN
Suffix:JR
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 1:101 CLEVELAND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3700
Mailing Address - Country:US
Mailing Address - Phone:276-634-5000
Mailing Address - Fax:276-634-5229
Practice Address - Street 1:101 CLEVELAND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3700
Practice Address - Country:US
Practice Address - Phone:276-634-5000
Practice Address - Fax:276-634-5229
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038299208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7503067Medicaid
VA1396799318Medicaid
VA212098OtherCIGNA
VA027132OtherANTHEM
NC7906965Medicaid
VA027132OtherANTHEM
VA4530330001Medicare NSC
VAC78298Medicare UPIN
VA1396799318Medicaid
NC2038209AMedicare PIN
018488P15Medicare PIN