Healthcare Provider Details

I. General information

NPI: 1457342958
Provider Name (Legal Business Name): PAUL ILIGAN GERALDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 EAST ST
TEWKSBURY MA
01876-1998
US

IV. Provider business mailing address

365 EAST ST
TEWKSBURY MA
01876-1998
US

V. Phone/Fax

Practice location:
  • Phone: 978-851-7321
  • Fax: 978-858-3795
Mailing address:
  • Phone: 978-851-7321
  • Fax: 978-858-3795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12490
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number216611
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: