Provider Demographics
NPI:1487722377
Name:TRINIDAD, GERARDO DUMLAO (MD)
Entity type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:DUMLAO
Last Name:TRINIDAD
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:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-4000
Mailing Address - Fax:
Practice Address - Street 1:1729 KINNEYS LN STE 102
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3166
Practice Address - Country:US
Practice Address - Phone:740-351-0980
Practice Address - Fax:740-351-0021
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075500207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64961956Medicaid
OH2121411Medicaid
OHBT4605804OtherDEA
OHBT4605804OtherDEA
OHHO2351Medicare UPIN