Provider Demographics
NPI:1578394144
Name:GERNHARDT, MICAELA (PA)
Entity type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:GERNHARDT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3836
Mailing Address - Country:US
Mailing Address - Phone:856-701-2588
Mailing Address - Fax:
Practice Address - Street 1:63 KRESSON RD STE 101C
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3200
Practice Address - Country:US
Practice Address - Phone:856-796-9340
Practice Address - Fax:856-547-0390
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NJ25MP00884200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant