MEDICARE: ERIC DEAN GEARHART PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	1053609
2	363AM0700X	Medical Physician Assistant	1634	SC

General Provider Information

NPI Number	:	1063491025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC DEAN GEARHART PA

Provider Business Mailing Address
First Line	:	PO BOX 6216A
Second Line	:	1 PINCKNEY BLVD NAVAL HOSPITAL BEAUFORT ATTN PROFESSION
City	:	BEAUFORT
State	:	SC
Zip	:	29902-6148
Country	:	US
Telephone Number	:	843-228-5577
Fax Number	:	843-228-5196

Provider Business Practice Location Address
First Line	:	10A MARSHELLEN DR
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29902-6900
Country	:	US
Telephone Number	:	843-525-9015
Fax Number	:	843-525-9020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	10/11/2011

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