Provider Demographics
NPI:1992768816
Name:GERDES, JOSEPH JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:GERDES
Suffix:
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 1:3030 LATROBE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4866
Mailing Address - Country:US
Mailing Address - Phone:704-362-1945
Mailing Address - Fax:704-770-0501
Practice Address - Street 1:3030 LATROBE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4866
Practice Address - Country:US
Practice Address - Phone:704-362-1945
Practice Address - Fax:704-770-0501
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC176302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8935116Medicaid
NC8935116Medicaid
NCC82454Medicare UPIN
300027973Medicare PIN
NC204269EMedicare PIN
NC212205AMedicare PIN