Provider Demographics
NPI:1154307114
Name:GHEARING, GENA R (MD)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:R
Last Name:GHEARING
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 MADISON AVE # 1052
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6508
Mailing Address - Country:US
Mailing Address - Phone:212-241-1261
Mailing Address - Fax:646-537-9690
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:2RCP
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-353-7323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-439372084N0400X, 2084N0600X
PAMD4316502084N0400X, 2084N0600X
NY3344542084E0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00399003OtherRAILROAD PALMETTO PA
PA1019195730001Medicaid
PA1967327OtherHIGHMARK MEDICARE MANAGED CARE
H65796Medicare UPIN
PA112266Medicare PIN