Healthcare Provider Details

I. General information

NPI: 1427258763
Provider Name (Legal Business Name): ERIC M GEIGLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 ALBANY AVE THE VILLAGE FOR FAMILIES AND CHILDREN
HARTFORD CT
06105-1001
US

IV. Provider business mailing address

1680 ALBANY AVE THE VILLAGE FOR FAMILIES AND CHILDREN
HARTFORD CT
06105-1001
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-4511
  • Fax: 860-231-8449
Mailing address:
  • Phone: 860-236-4511
  • Fax: 860-231-8449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number047998
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: