Provider Demographics
NPI:1255101036
Name:GEARHART, JACOB MATTHEW (IDC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:MATTHEW
Last Name:GEARHART
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 EASTLAND RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-1723
Mailing Address - Country:US
Mailing Address - Phone:717-404-2297
Mailing Address - Fax:
Practice Address - Street 1:3RD RECON BATTALION, H&S, BAS
Practice Address - Street 2:UNIT 36180
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96389-6180
Practice Address - Country:US
Practice Address - Phone:315-625-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman