Healthcare Provider Details
I. General information
NPI: 1316943285
Provider Name (Legal Business Name): ANGELA G GEDDIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/24/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
184 EAST ST
PLAINVILLE CT
06062-2913
US
IV. Provider business mailing address
300 KENSINGTON AVE
NEW BRITAIN CT
06051-3916
US
V. Phone/Fax
- Phone: 860-747-1132
- Fax: 860-747-2028
- Phone: 860-224-6282
- Fax: 860-826-4959
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 031048 |
| License Number State | CT |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 060040 |
| Identifier Type | OTHER |
| Identifier State | CT |
| Identifier Issuer | HEALTH NET ID |
| # 2 | |
| Identifier | 1255448155 |
| Identifier Type | OTHER |
| Identifier State | CT |
| Identifier Issuer | GHMC NPI ID |
| # 3 | |
| Identifier | 476805 |
| Identifier Type | OTHER |
| Identifier State | CT |
| Identifier Issuer | AETNA REF ID |
| # 4 | |
| Identifier | 010031048CT03 |
| Identifier Type | OTHER |
| Identifier State | CT |
| Identifier Issuer | BCBS NBCFP PLAINVILLE ID |
| # 5 | |
| Identifier | 010031048CT04 |
| Identifier Type | OTHER |
| Identifier State | CT |
| Identifier Issuer | BCBSN BCFP NB ID |
| # 6 | |
| Identifier | 01031048 |
| Identifier Type | OTHER |
| Identifier State | CT |
| Identifier Issuer | CIGNA ID |
| # 7 | |
| Identifier | 912429 |
| Identifier Type | OTHER |
| Identifier State | CT |
| Identifier Issuer | HEALTH NET REF ID |
| # 8 | |
| Identifier | 71668401 |
| Identifier Type | OTHER |
| Identifier State | CT |
| Identifier Issuer | CONNECTICARE ID |
| # 9 | |
| Identifier | P369863 |
| Identifier Type | OTHER |
| Identifier State | CT |
| Identifier Issuer | OXFORD ID |
| # 10 | |
| Identifier | 126638 |
| Identifier Type | OTHER |
| Identifier State | CT |
| Identifier Issuer | WELLCARE MEDICARE |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
