Provider Demographics
NPI:1992800379
Name:GERSH, ELLIOT STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:STEPHEN
Last Name:GERSH
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 1:13922 BALTIMORE AVE
Mailing Address - Street 2:4A CHILDRENS NATIONAL MEDICAL CENTER
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707
Mailing Address - Country:US
Mailing Address - Phone:301-369-4100
Mailing Address - Fax:301-369-0092
Practice Address - Street 1:13922 BALTIMORE AVE
Practice Address - Street 2:4A CHILDRENS NATIONAL MEDICAL CENTER
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707
Practice Address - Country:US
Practice Address - Phone:301-369-4100
Practice Address - Fax:301-369-0092
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD22278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics