Provider Demographics
NPI:1437510526
Name:GERSON, RUTH DIANA (CNM)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:DIANA
Last Name:GERSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41680 MISS BESSIE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2963
Mailing Address - Country:US
Mailing Address - Phone:301-997-1788
Mailing Address - Fax:301-997-1790
Practice Address - Street 1:41680 MISS BESSIE DR STE 102
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2963
Practice Address - Country:US
Practice Address - Phone:301-997-1788
Practice Address - Fax:301-997-1790
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR221031367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife