Healthcare Provider Details

I. General information

NPI: 1730808460
Provider Name (Legal Business Name): MIRANDA LOUISE GEYER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRANDA LOUISE KELLY

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 E MAIN ST
LEOLA PA
17540-1964
US

IV. Provider business mailing address

825 N HANOVER ST
ELIZABETHTOWN PA
17022-1304
US

V. Phone/Fax

Practice location:
  • Phone: 717-656-2141
  • Fax:
Mailing address:
  • Phone: 717-381-5207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA063873
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: