Provider Demographics
NPI:1962408047
Name:GERSTEN, TODD ADAM (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:ADAM
Last Name:GERSTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:1037 S STATE ROAD 7
Practice Address - Street 2:SUITE 303
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6140
Practice Address - Country:US
Practice Address - Phone:561-366-4100
Practice Address - Fax:561-798-5581
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME83684207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269806400Medicaid
FL43313WMedicare PIN
FLG91877Medicare UPIN