Provider Demographics
NPI:1174560056
Name:GERBSTADT, CHRISTINE R (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:GERBSTADT
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 1:4721 HAMLETS GROVE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-2237
Mailing Address - Country:US
Mailing Address - Phone:412-638-0000
Mailing Address - Fax:814-237-4917
Practice Address - Street 1:4721 HAMLETS GROVE DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-2237
Practice Address - Country:US
Practice Address - Phone:412-638-0000
Practice Address - Fax:814-237-4917
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
PAMD049226L207L00000X
FLME90451207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001417640Medicaid
PA001417640Medicaid
PA731611Medicare ID - Type Unspecified