Healthcare Provider Details

I. General information

NPI: 1144457565
Provider Name (Legal Business Name): BETHANY MARIA GEIB-ROSCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR DEPARTMENT OF PSYCHIATRY, CB#7160
CHAPEL HILL NC
27599-0001
US

IV. Provider business mailing address

300 VEAZEY DR
BUTNER NC
27509-1668
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-1072
  • Fax: 919-966-2220
Mailing address:
  • Phone: 919-764-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number2013-01459
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number157131
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: