Provider Demographics
NPI:1164620720
Name:GERETY, PATRICK A (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:A
Last Name:GERETY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:545 BARNHILL DR
Mailing Address - Street 2:EH 232
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5112
Mailing Address - Country:US
Mailing Address - Phone:317-944-3636
Mailing Address - Fax:317-278-7159
Practice Address - Street 1:545 BARNHILL DR
Practice Address - Street 2:EH 232
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5112
Practice Address - Country:US
Practice Address - Phone:317-944-3636
Practice Address - Fax:317-278-7159
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01077425A208200000X
PAMT191327208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery