Provider Demographics
NPI:1861451957
Name:PACKER, GERALD A (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:A
Last Name:PACKER
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 1:5659 PARKWAY DR
Mailing Address - Street 2:STE 100
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-3792
Mailing Address - Country:US
Mailing Address - Phone:804-210-1005
Mailing Address - Fax:804-210-1009
Practice Address - Street 1:5659 PARKWAY DR
Practice Address - Street 2:STE 100
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-3792
Practice Address - Country:US
Practice Address - Phone:804-210-1005
Practice Address - Fax:804-210-1009
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031360207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010046793Medicaid
003005S33Medicare ID - Type Unspecified
D98351Medicare UPIN