Basic Information
| Provider Information | |||||||||
| NPI: | 1144457565 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEIB-ROSCH | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | MARIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 VEAZEY DR | ||||||||
| Address2: | |||||||||
| City: | BUTNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275091668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197642237 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 MANNING DR | ||||||||
| Address2: | DEPARTMENT OF PSYCHIATRY, CB#7160 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199661072 | ||||||||
| FaxNumber: | 9199662220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2009 | ||||||||
| LastUpdateDate: | 10/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 157131 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 283Q00000X | 2013-01459 | NC | Y | Hospitals | Psychiatric Hospital |
No ID Information.