Basic Information
| Provider Information | |||||||||
| NPI: | 1821051038 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BULL | ||||||||
| FirstName: | GEOFFREY | ||||||||
| MiddleName: | LATHROP | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 WESTVIEW DR | ||||||||
| Address2: | |||||||||
| City: | BEAVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150091460 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 850 S HERMITAGE RD | ||||||||
| Address2: | SUITE B15 | ||||||||
| City: | HERMITAGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161483679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249831355 | ||||||||
| FaxNumber: | 7249811605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 12/29/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 34.004686 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | OS007030E | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0746394 | 05 | OH | MEDICAID | 047550 | 01 | PA | HIGHMARK BS | OTHER |