Provider Demographics
NPI:1679786669
Name:STREETS, GERALD M (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:M
Last Name:STREETS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22868 ROUTE 68 STE 5
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8566
Mailing Address - Country:US
Mailing Address - Phone:814-227-2941
Mailing Address - Fax:814-227-2946
Practice Address - Street 1:22868 ROUTE 68 STE 5
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8566
Practice Address - Country:US
Practice Address - Phone:814-227-2941
Practice Address - Fax:814-227-2946
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040275E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAFS0217314OtherDEA