Provider Demographics
NPI:1750331567
Name:WILLWERTH, GERALD E (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:E
Last Name:WILLWERTH
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 1:112 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201
Mailing Address - Country:US
Mailing Address - Phone:717-267-7146
Mailing Address - Fax:717-267-7728
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-267-7146
Practice Address - Fax:717-267-7728
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041447E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001257321Medicaid
930045526Medicare PIN
550955GOEMedicare ID - Type Unspecified