Basic Information
| Provider Information | |||||||||
| NPI: | 1457490211 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERHART | ||||||||
| FirstName: | CORINNE | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043846478 | ||||||||
| FaxNumber: | 7043848220 | ||||||||
| Practice Location | |||||||||
| Address1: | 324 N MCDOWELL ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043846478 | ||||||||
| FaxNumber: | 7043848220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2021-02128 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS9449 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QH0002X | 2021-02128 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 92761 | 01 | FL | BCBS | OTHER | 201841070 | 01 | FL | TAX ID | OTHER | 277624300 | 05 | FL | MEDICAID |