Provider Demographics
NPI:1144278037
Name:GEBHARDT, GARREN P (DO)
Entity type:Individual
Prefix:
First Name:GARREN
Middle Name:P
Last Name:GEBHARDT
Suffix:
Gender:M
Credentials:DO
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 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:435 SOUTH ST STE 160
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6477
Practice Address - Country:US
Practice Address - Phone:973-971-6301
Practice Address - Fax:973-290-7169
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003217A204C00000X
OK7091204D00000X
NJ25MB11977300204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6961878OtherCIGNA HMO
IN201269220Medicaid
VT49712OtherBLUE CROSS/BLUE SHIELD
IN093299OtherSIHO
IN000000552067OtherANTHEM
VT030371536OtherCIGNA PPO
OK1I4071OtherMEDICARE
OK200939790AMedicaid
IN7365329OtherAETNA
INPO1457038OtherRAIL ROAD PTAN
IN201269220Medicaid
IN255280AMedicare PIN