Provider Demographics
NPI:1215089099
Name:GEFFERT, GWENDOLYN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:LEE
Last Name:GEFFERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5842 ALLIN RD
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-2363
Mailing Address - Country:US
Mailing Address - Phone:804-862-4414
Mailing Address - Fax:804-862-3203
Practice Address - Street 1:5842 ALLIN RD
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-2363
Practice Address - Country:US
Practice Address - Phone:804-862-4414
Practice Address - Fax:804-862-3203
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7609261OtherAETNA PPO
VA154898OtherSOUTHERN HEALTH
VA111514OtherCIGNA
VA3489701OtherAETNA HMO
VA5621097Medicaid
VA286055OtherANTHEM BLUE CROSS BLUE SH
VA3489701OtherAETNA
VA8122303OtherMAMSI
VA3489701OtherAETNA HMO