Provider Demographics
NPI:1285786962
Name:GEISBERG, HARRY IRVIN (M D)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:IRVIN
Last Name:GEISBERG
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E GREENVILLE ST
Mailing Address - Street 2:SUITE #1600
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1580
Mailing Address - Country:US
Mailing Address - Phone:864-226-9193
Mailing Address - Fax:864-716-6732
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE #1600
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-226-9193
Practice Address - Fax:864-716-6732
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC069972Medicaid
SC069972Medicaid