Provider Demographics
NPI:1063491025
Name:GEARHART, ERIC DEAN (PA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DEAN
Last Name:GEARHART
Suffix:
Gender:M
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:PO BOX 6216A
Mailing Address - Street 2:1 PINCKNEY BLVD NAVAL HOSPITAL BEAUFORT ATTN PROFESSION
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6148
Mailing Address - Country:US
Mailing Address - Phone:843-228-5577
Mailing Address - Fax:843-228-5196
Practice Address - Street 1:10A MARSHELLEN DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6900
Practice Address - Country:US
Practice Address - Phone:843-525-9015
Practice Address - Fax:843-525-9020
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1053609363AM0700X
SC1634363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OTHMedicare UPIN