Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 227183 | MA |
Y | 207RI0011X | Interventional Cardiology | 227183 | MA |
NPI | 1104884022 |
---|---|
Provider Name | Jean-Pierre M. Geagea |
First Address | Brockton, MA 02302-3308 |
Second Address | Brockton, MA 02302-3308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 14/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2119501 | (05) | MA |
H63826 | (02) | MA |