Basic Information
| Provider Information | |||||||||
| NPI: | 1861497778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEFFKEN | ||||||||
| FirstName: | DOMINIC | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 PLEASANT ST | ||||||||
| Address2: | YEAPLE BUILDING | ||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033017539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032287200 | ||||||||
| FaxNumber: | 6032287307 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 PLEASANT ST | ||||||||
| Address2: | YEAPLE BUILDING | ||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033017539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032287200 | ||||||||
| FaxNumber: | 6032287307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 08/23/2011 | ||||||||
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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 | 12378 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine | 2083P0901X | 12378 | NH | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine |
ID Information
| ID | Type | State | Issuer | Description | 222594672 | 01 | NH | HEALTHCARE VALUE MANAGE | OTHER | 222594672 | 01 | NH | TRICARE | OTHER | 222594672 | 01 | NH | UNITED HEALTH CARE | OTHER | 4126900 | 01 | NH | MVP HEALTHCARE | OTHER | 80300001 | 05 | NH | MEDICAID | 222594672 | 01 | NH | PRIVATE HEALTH CARE | OTHER | 222594672 | 01 | NH | GREATWEST HEALTHCARE | OTHER | 01YP07636NH01 | 01 | NH | ANTHEM | OTHER | 2139351 | 01 | NH | CIGNA | OTHER | 7445605 | 01 | NH | AETNA | OTHER | AA15532 | 01 | NH | HARVARD PILGRIM | OTHER |