Healthcare Provider Details

I. General information

NPI: 1578610127
Provider Name (Legal Business Name): GEORGE RYAN GEEHAN JR. M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 RESERVOIR AVE SUITE 305B
CRANSTON RI
02920-6068
US

IV. Provider business mailing address

1150 RESERVOIR AVENUE STE. 305B
CRANSTON RI
02920
US

V. Phone/Fax

Practice location:
  • Phone: 401-942-8080
  • Fax: 401-942-3666
Mailing address:
  • Phone: 401-942-8080
  • Fax: 401-942-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD00042
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: