Basic Information
| Provider Information | |||||||||
| NPI: | 1609861194 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEARY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 92 HIGHLAND ST | ||||||||
| Address2: | ATTN K BOYER CPA | ||||||||
| City: | MILTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021863800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176964600 | ||||||||
| FaxNumber: | 7819865801 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HIGHLAND ST | ||||||||
| Address2: | STE 125 | ||||||||
| City: | MILTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021863881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176964600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 01/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 648 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.