Healthcare Provider Details

I. General information

NPI: 1811799331
Provider Name (Legal Business Name): GEOFFREY ROGERS O'MALLEY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W. 86TH STREET 1 NORTH
INDIANAPOLIS IN
46260
US

IV. Provider business mailing address

2001 W. 86TH STREET 1 NORTH
INDIANAPOLIS IN
46260
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-2281
  • Fax: 317-338-2851
Mailing address:
  • Phone: 317-338-2281
  • Fax: 317-338-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: