Provider Demographics
NPI:1649267188
Name:GAERTNER, WILLIAM RONALD (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RONALD
Last Name:GAERTNER
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 1:621 EMANCIPATION HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4567
Mailing Address - Country:US
Mailing Address - Phone:540-372-2028
Mailing Address - Fax:540-372-6541
Practice Address - Street 1:621 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-372-2028
Practice Address - Fax:540-372-6541
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010350452084A0401X, 2084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
458104000OtherMAGELLAN
51337OtherCIGNA
861112647OtherUBH
VA071985427Medicaid
146004OtherANTHEM
081522OtherOPTIMA
307350OtherANTHEM
347OtherVALUE OPTIONS
4076171OtherAETNA
4076171OtherAETNA
146004OtherANTHEM
861112647OtherUBH