MEDICARE: BETHANY MARIA GEIB-ROSCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	157131	NC
2	283Q00000X	Psychiatric Hospital	2013-01459	NC

General Provider Information

NPI Number	:	1144457565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY MARIA GEIB-ROSCH MD

Provider Business Mailing Address
First Line	:	300 VEAZEY DR
Second Line	:
City	:	BUTNER
State	:	NC
Zip	:	27509-1668
Country	:	US
Telephone Number	:	919-764-2237
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 MANNING DR
Second Line	:	DEPARTMENT OF PSYCHIATRY, CB#7160
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-0001
Country	:	US
Telephone Number	:	919-966-1072
Fax Number	:	919-966-2220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	10/01/2015

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