Provider Demographics
NPI:1063498772
Name:GEISSINGER, WILLIAM T (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:GEISSINGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1918 RANDOLPH RD., STE. 130
Mailing Address - Street 2:SURGICAL SPECIALISTS OF CHARLOTTE, P.A.
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1107
Mailing Address - Country:US
Mailing Address - Phone:704-364-8100
Mailing Address - Fax:704-365-2073
Practice Address - Street 1:1918 RANDOLPH RD., SUITE 130
Practice Address - Street 2:SURGICAL SPECIALISTS OF CHARLOTTE, P.A.
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207
Practice Address - Country:US
Practice Address - Phone:704-364-8100
Practice Address - Fax:704-365-2073
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC18450208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-35055Medicaid
NC8935055Medicaid
NC89-35055Medicaid
NCE23570Medicare UPIN
NC206562BMedicare ID - Type UnspecifiedCTS MEDICARE NUMBER
206562Medicare PIN