Healthcare Provider Details

I. General information

NPI: 1679764492
Provider Name (Legal Business Name): GERALDINE GO FERIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 SOUTH OHIO ST
WANATAH IN
46390
US

IV. Provider business mailing address

218 DUNDEE ST
VALPARAISO IN
46385-7738
US

V. Phone/Fax

Practice location:
  • Phone: 219-733-2755
  • Fax: 219-733-2377
Mailing address:
  • Phone: 219-252-2507
  • Fax: 219-733-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01068503A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01068503A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: