Provider Demographics
NPI:1659689883
Name:GERALD SHOWALTER, PSY.D., P.C.
Entity Type:Organization
Organization Name:GERALD SHOWALTER, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHOWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:540-447-0134
Mailing Address - Street 1:1009 LYNDHURST RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-5532
Mailing Address - Country:US
Mailing Address - Phone:540-447-0134
Mailing Address - Fax:540-941-1076
Practice Address - Street 1:1320 OHIO ST STE M
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-2467
Practice Address - Country:US
Practice Address - Phone:540-447-0134
Practice Address - Fax:540-941-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000262103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7714386Medicaid
VA680001314Medicare PIN