Provider Demographics
NPI:1619006954
Name:GEARHART, LORIE A (MD)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:A
Last Name:GEARHART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BAY AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2102
Mailing Address - Country:US
Mailing Address - Phone:831-427-3100
Mailing Address - Fax:831-515-7037
Practice Address - Street 1:820 BAY AVE STE 206
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2102
Practice Address - Country:US
Practice Address - Phone:831-427-3100
Practice Address - Fax:831-515-7037
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA979942084F0202X, 2084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70042FMedicaid
CAFHC70044FMedicaid
CAZZZ91891ZOtherSANTA CRUZ COUNTY MEDICARE GROUP
CAZZZ92069ZOtherSANTA CRUZ COUNTY MEDICARE GROUP
CAZZZ91892ZOtherSANTA CRUZ COUNTY MEDICARE GROUP