1255302527 NPI number — DR. ELISE WEINRICH GEARY MD

Table of content: MICHAEL S PARKER MD (NPI 1881633360)

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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