Provider Demographics
NPI:1851366389
Name:PARKER, GERALD A (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:A
Last Name:PARKER
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:PO BOX 602458
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2458
Mailing Address - Country:US
Mailing Address - Phone:910-291-6904
Mailing Address - Fax:910-291-6907
Practice Address - Street 1:500 LAUCHWOOD DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5501
Practice Address - Country:US
Practice Address - Phone:910-291-6904
Practice Address - Fax:910-291-6907
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040135L174400000X
NC151550207R00000X
NC2008-02004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN02004Medicaid
PA011268782Medicaid
NC5911199Medicaid
NC1851366389Medicaid
PAC33225Medicare UPIN
NC5911199Medicaid
PA193596PD9Medicare PIN
PA011268782Medicaid