Basic Information
| Provider Information | |||||||||
| NPI: | 1073741153 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GERMEROTH | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | RUSSUM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 GREEN VALLEY RD | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362824840 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 N ELAM AVE | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274031118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362824840 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2009 | ||||||||
| LastUpdateDate: | 09/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | TRN-14880 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 2013-00962 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 208600000X | LL31888 | SC | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | TL31888 | 01 | SC | SOUTH CAROLINA BOARD OF MEDICAL EXAMINERS | OTHER | TRN-14880 | 01 | FL | FLORIDA BOARD OF MEDICINE | OTHER | 2013-00962 | 01 | NC | NORTH CAROLINA MEDICAL BOARD | OTHER |