1255302527 NPI number — DR. ELISE WEINRICH GEARY MD

Table of content: DR. ELISE WEINRICH GEARY MD (NPI 1255302527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255302527 NPI number — DR. ELISE WEINRICH GEARY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEARY
Provider First Name:
ELISE
Provider Middle Name:
WEINRICH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEINRICH
Provider Other First Name:
ANN
Provider Other Middle Name:
ELISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255302527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1955 22ND AVE
Provider Second Line Business Mailing Address:
VERO BEACH DERMATOLOGY
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32960-3083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-299-0085
Provider Business Mailing Address Fax Number:
772-978-4193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1955 22ND AVE
Provider Second Line Business Practice Location Address:
VERO BEACH DERMATOLOGY
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32960-3083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-299-0085
Provider Business Practice Location Address Fax Number:
772-978-4193
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  26404 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 26404 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1042W . This is a "BCBS OF NORTH CAROLINA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 54573 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 02001260 . This is a "UNITEDHEALTH CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8986324 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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