Provider Demographics
NPI:1487875340
Name:GREGORY D KERSH D C P C
Entity type:Organization
Organization Name:GREGORY D KERSH D C P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KERSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-998-3111
Mailing Address - Street 1:9351 LAKESIDE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5062
Mailing Address - Country:US
Mailing Address - Phone:410-998-3111
Mailing Address - Fax:410-998-3113
Practice Address - Street 1:9351 LAKESIDE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5062
Practice Address - Country:US
Practice Address - Phone:410-998-3111
Practice Address - Fax:410-998-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01706111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD187207OtherMEDICARE PTAN -DBA - NEW TOWN CHIRO...
MH297921OtherMAMSI, MDIPA, OPT CH. ID
MD187205YBVUOtherMEDICARE PTAN INDIVIDUAL
MH4595917OtherAETNA ID NUMBER
MDE301OtherBLUE CHOICE,FEDERAL BCBS
MDM453OtherCAREFIRST BCBS ID
MD870QMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID
MDU72064Medicare UPIN