MEDICARE: DR. GEOFFREY G MOUNTVARNER M.D.

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	207P00000X	Emergency Medicine Physician	D0054648	MD

General Provider Information

NPI Number	:	1316947617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEOFFREY G MOUNTVARNER M.D.

Provider Business Mailing Address
First Line	:	12710 WOODBRIDGE CT
Second Line	:
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-4243
Country	:	US
Telephone Number	:	202-865-1121
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 GEORGIA AVE NW
Second Line	:	EMERGENCY DEPT ADMIN OFFICE
City	:	WASHINGTON
State	:	DC
Zip	:	20060-0001
Country	:	US
Telephone Number	:	202-865-1121
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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