Healthcare Provider Details

I. General information

NPI: 1518938646
Provider Name (Legal Business Name): CORNELIUS MARVIN GEISSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 GLASGOW ST
STOWE PA
19464-6557
US

IV. Provider business mailing address

1610 MEDICAL DR SUITE 310
POTTSTOWN PA
19464-3292
US

V. Phone/Fax

Practice location:
  • Phone: 484-945-0770
  • Fax: 484-945-0648
Mailing address:
  • Phone: 484-945-0405
  • Fax: 484-945-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS004823L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: