MEDICARE: RYAN TYLER GERACIMOS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	C1-0007587	DE
2	2085R0202X	Diagnostic Radiology Physician	D66292	MD

General Provider Information

NPI Number	:	1376688531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN TYLER GERACIMOS MD

Provider Business Mailing Address
First Line	:	200 S BRIDGE ST
Second Line	:
City	:	ELKTON
State	:	MD
Zip	:	21921-5915
Country	:	US
Telephone Number	:	410-620-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S BRIDGE ST
Second Line	:
City	:	ELKTON
State	:	MD
Zip	:	21921-5915
Country	:	US
Telephone Number	:	410-620-1900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	01/16/2008

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