1629075114 NPI number — DR. WILLIAM A GEARY M.D., PHD

Table of content: DR. WILLIAM A GEARY M.D., PHD (NPI 1629075114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629075114 NPI number — DR. WILLIAM A GEARY M.D., PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEARY
Provider First Name:
WILLIAM
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629075114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 FOOTE AVE
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14701-6947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-338-9236
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 FOOTE AVE
Provider Second Line Business Practice Location Address:
PATHOLOGY LAB
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14701-7077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-338-9236
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2005

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: 207ZP0102X , with the licence number:  227790 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5098769 . This is a "GHI MAIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000527319007 . This is a "BCBS OF WNY UAR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02429578 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000527319003 . This is a "BCBS OF WNY WNYUA" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 000527319008 . This is a "BCBS OF WNY MAIN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 041015000034 . This is a "FIDELIS WNYUA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00026388902 . This is a "UNIVERA WNYUA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 061124000076 . This is a "FIDELIS MAIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00026388905 . This is a "UNIVERA UAR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5098730 . This is a "GHI UAR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00026388904 . This is a "UNIVERA MAIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1111653 . This is a "IHA ALL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5099083 . This is a "GHI WNYUA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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