Provider Demographics
NPI:1003861360
Name:DEWITT, GERALD W (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:W
Last Name:DEWITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4038 THOMAS NELSON HWY
Mailing Address - Street 2:
Mailing Address - City:ARRINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22922
Mailing Address - Country:US
Mailing Address - Phone:434-263-4000
Mailing Address - Fax:434-263-4160
Practice Address - Street 1:4038 THOMAS NELSON HWY
Practice Address - Street 2:
Practice Address - City:ARRINGTON
Practice Address - State:VA
Practice Address - Zip Code:22922
Practice Address - Country:US
Practice Address - Phone:434-263-4000
Practice Address - Fax:434-263-4160
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101019845208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
154019OtherANTHEM
249647OtherSOUTHERN HEALTH
54-1778786OtherFIRST HEALTH/MAIL HANDLER
8128043OtherMAMSI/MDIPA
VA010123879Medicaid
54-1778786OtherPHCS
54-1778786OtherVA HEALTH NETWORK
12-00465OtherUNITED HEALTHCARE
1485127009OtherCIGNA
4305649OtherAETNA TRADITIONAL
54-1778786OtherMID ATLANTIC HEALTH SOLUT
010123879OtherVA PREMIERE HELTH PLAN
2177792OtherAETNA HMO
54-1778786OtherCCN
53854OtherSENTARA/OPTIMA
54-1778786-032OtherCHAMPUS/TRICARE
B65360Medicare UPIN