Provider Demographics
NPI:1699730838
Name:GEIGER, EDWIN L (EDD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:L
Last Name:GEIGER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MAIN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053
Mailing Address - Country:US
Mailing Address - Phone:508-533-6200
Mailing Address - Fax:508-533-6202
Practice Address - Street 1:165 MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053
Practice Address - Country:US
Practice Address - Phone:508-533-6200
Practice Address - Fax:508-533-6202
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6279103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05038OtherBCBS
MA0524425Medicaid
MAMA0524425Medicaid
MA0524425Medicaid