Healthcare Provider Details

I. General information

NPI: 1720224496
Provider Name (Legal Business Name): LAURA GERAGHTY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA GOULD PA-C

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DUMC 3805
DURHAM NC
27710-0001
US

IV. Provider business mailing address

17 FLOWERING APRICOT DR
DURHAM NC
27703-6362
US

V. Phone/Fax

Practice location:
  • Phone: 919-613-4573
  • Fax:
Mailing address:
  • Phone: 412-401-1736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC0003931
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0010-01923
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: