Basic Information
| Provider Information | |||||||||
| NPI: | 1851380059 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEIBEL | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 GROTON ROAD | ||||||||
| Address2: | NASHOBA VALLEY HEALTHCARE GROUP | ||||||||
| City: | AYER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787849000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 697 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | LUNENBURG | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785824587 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 03/16/2009 | ||||||||
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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 | 207Q00000X | 44624 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | SX1740 | 01 | MA | PTAN | OTHER | SX1727 | 01 | MA | PTAN 41 | OTHER | 2071495 | 05 | MA | MEDICAID |