Healthcare Provider Details

I. General information

NPI: 1790763340
Provider Name (Legal Business Name): BETH A. GERALDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST EMERGENCY DEPT
CONCORD NH
03301-7539
US

IV. Provider business mailing address

250 PLEASANT ST EMERGENCY DEPT
CONCORD NH
03301-7539
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-7000
  • Fax: 603-230-7218
Mailing address:
  • Phone: 603-225-7000
  • Fax: 603-230-7218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50-001731
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0806
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: