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General NPI Number Information
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NPI Number | 1316259708
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Entity Type | Individual
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Provider Name | GEOFFREY S. FASEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 2945 HAZELWOOD ST STE 100
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1242
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Country | US
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Telephone | 651-227-6351
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Fax | 651-227-1134
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Provider Business Mailing Address
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Address Line | PO BOX 9007
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22906-9007
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101258324
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 54101
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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