=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619970639
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID FRANCIS GEISS D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2005
-----------------------------------------------------
Last Update Date | 03/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 NEWARK GRANVILLE RD STE 202
-----------------------------------------------------
City | GRANVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43023-9135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-587-3376
-----------------------------------------------------
Fax | 740-587-1424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 N EWING ST
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43130-3307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-687-1177
-----------------------------------------------------
Fax | 740-344-5661
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 34005696G
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------