Healthcare Provider Details

I. General information

NPI: 1801879580
Provider Name (Legal Business Name): DWIGHT G. GEHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

PO BOX 9142
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-8980
  • Fax: 617-726-5985
Mailing address:
  • Phone: 617-724-0287
  • Fax: 617-724-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number35335
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: