Provider Demographics
NPI:1427111053
Name:GERENA, RAMON SR (MD)
Entity type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:GERENA
Suffix:SR
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:PO BOX 52327
Mailing Address - Street 2:LEVITTOWN STATION
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-2327
Mailing Address - Country:US
Mailing Address - Phone:787-261-0740
Mailing Address - Fax:787-784-4246
Practice Address - Street 1:JR4 CLIZZIE GRAHAM 7TH SECC
Practice Address - Street 2:URB LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-261-0740
Practice Address - Fax:787-784-4246
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5403208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0027091Medicare ID - Type Unspecified
C79621Medicare UPIN