Provider Demographics
NPI:1528054558
Name:HERALD, GEOFFREY R (MD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:R
Last Name:HERALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2333
Mailing Address - Country:US
Mailing Address - Phone:724-775-2112
Mailing Address - Fax:724-775-2131
Practice Address - Street 1:274 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2333
Practice Address - Country:US
Practice Address - Phone:724-775-2112
Practice Address - Fax:724-775-2131
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026909E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010040690004Medicaid
PAB37282Medicare UPIN
PA0010040690004Medicaid