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Individual

DR. ELENA GERTSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D., PH.D.

Contact information

Practice address
1725 W MARKET ST, JOHNSON CITY, TN 37604-6020
(423) 431-1310
Mailing address
1725 W MARKET ST, JOHNSON CITY, TN 37604-6020
(423) 431-1310

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
0101251153
VA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
48798
TN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
55622
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
103I223230
MEDICARE
TN
05
ENROLLED
IA
05
ENROLLED
MN
05
Q003153
TN
Enumeration date
07/18/2008
Last updated
08/09/2016
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