Healthcare Provider Details

I. General information

NPI: 1689077893
Provider Name (Legal Business Name): GEPS PHYSICIAN GROUP OF PENNSYLVANIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 NW 95TH ST
SEATTLE WA
98117
US

IV. Provider business mailing address

PO BOX 42738
TOWSON MD
21284-2738
US

V. Phone/Fax

Practice location:
  • Phone: 206-782-0100
  • Fax:
Mailing address:
  • Phone: 410-494-7607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC SHAPIRO
Title or Position: VICE PRESIDENT
Credential:
Phone: 410-832-7790