Provider Demographics
NPI:1588696058
Name:GERASSIMAKIS, CONSTANCE S (MD)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:S
Last Name:GERASSIMAKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CASSINA DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-9184
Mailing Address - Country:US
Mailing Address - Phone:302-378-6017
Mailing Address - Fax:
Practice Address - Street 1:119 CASSINA DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-9184
Practice Address - Country:US
Practice Address - Phone:302-378-6017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0674752085R0202X
MDD0065586208D00000X
OH35.067475208D00000X
DEC1-0003051208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH300120838OtherRRMC
OH0264422Medicaid
OHCC3678OtherRRMC
OH300120838OtherRRMC
OH0817592Medicare PIN
OHF04363Medicare UPIN
OH0817596Medicare PIN
OH0817594Medicare PIN
OH0817595Medicare PIN