Basic Information
| Provider Information | |||||||||
| NPI: | 1821218231 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GERAGHTY | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | RAUSCH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 WESTHALL LN FL 4 | ||||||||
| Address2: | |||||||||
| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327517102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072002700 | ||||||||
| FaxNumber: | 4072004947 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 WATERMAN WAY | ||||||||
| Address2: | MAMMOGRAPHY CENTER | ||||||||
| City: | TAVARES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327785266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522533235 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 08/16/2018 | ||||||||
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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 | 2085R0202X | MD00049452 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | ME131495 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1060586 | 05 | WA | MEDICAID | 0234159 | 01 | WA | LABOR & INDUSTRIES | OTHER | 8510141 | 05 | WA | MEDICAID | 8947055 | 01 | WA | CRIME VICTIMS | OTHER | 279998 | 01 | WA | L&I | OTHER |