Provider Demographics
NPI:1699735647
Name:GEAGAN, THOMAS V (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:V
Last Name:GEAGAN
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:PO BOX 6002
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02742-6002
Mailing Address - Country:US
Mailing Address - Phone:508-985-5020
Mailing Address - Fax:508-985-5038
Practice Address - Street 1:194 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571
Practice Address - Country:US
Practice Address - Phone:508-291-4450
Practice Address - Fax:508-295-6792
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA29363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0131113Medicaid
A65806Medicare UPIN
MAM06188Medicare ID - Type Unspecified