Provider Demographics
NPI:1023176823
Name:GERSON, ROBERTA BEVERLY (DO)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:BEVERLY
Last Name:GERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 POOL ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9575
Mailing Address - Country:US
Mailing Address - Phone:207-282-9008
Mailing Address - Fax:
Practice Address - Street 1:2 LIVEWELL DR
Practice Address - Street 2:GOODALL OCCUPATIONAL HEALTH CENTER
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6762
Practice Address - Country:US
Practice Address - Phone:207-490-7801
Practice Address - Fax:207-604-1018
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME12322083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1232OtherSTATE LICENSE NUMBER
ME1232OtherSTATE LICENSE NUMBER
MEMM241701Medicare UPIN
ME1232OtherSTATE LICENSE NUMBER
ME0010325Medicare PIN