Provider Demographics
NPI:1609847136
Name:SHOWALTER, GERALD R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:R
Last Name:SHOWALTER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-2215
Mailing Address - Country:US
Mailing Address - Phone:540-447-0134
Mailing Address - Fax:
Practice Address - Street 1:27 STONERIDGE DR
Practice Address - Street 2:STE A01
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-6583
Practice Address - Country:US
Practice Address - Phone:540-447-0134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000262103TC0700X
FLPY10639103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007712197Medicaid
VAS84119Medicare UPIN
VA007712197Medicaid
VA1558449223Medicare PIN
VA680001556Medicare ID - Type Unspecified