Basic Information
| Provider Information | |||||||||
| NPI: | 1114905551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOERTZEN | ||||||||
| FirstName: | GERALDINE | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 CALLOWAY ST | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218043200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103346351 | ||||||||
| FaxNumber: | 4103346352 | ||||||||
| Practice Location | |||||||||
| Address1: | 8163 OCEAN GTWY | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216017145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108200581 | ||||||||
| FaxNumber: | 4108200237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | D0047698 | MD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 354391900 | 05 | MD | MEDICAID |