Provider Demographics
NPI:1285616722
Name:URSE, GERALDINE LEE (DO)
Entity type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:LEE
Last Name:URSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:GERALDINE
Other - Middle Name:NOBLE
Other - Last Name:URSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2030 STRINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-3993
Mailing Address - Country:US
Mailing Address - Phone:614-544-0101
Mailing Address - Fax:614-544-0102
Practice Address - Street 1:2030 STRINGTOWN RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3993
Practice Address - Country:US
Practice Address - Phone:614-544-0101
Practice Address - Fax:614-544-0102
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH005976207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0236588Medicaid
G42673Medicare UPIN
OH0236588Medicaid