Provider Demographics
NPI:1164696878
Name:GIBNEY, GEOFFREY T (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:T
Last Name:GIBNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418283
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8283
Mailing Address - Country:US
Mailing Address - Phone:703-558-1456
Mailing Address - Fax:703-558-1445
Practice Address - Street 1:3970 RESERVOIR RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2126
Practice Address - Country:US
Practice Address - Phone:202-444-7064
Practice Address - Fax:202-444-1229
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD042897207R00000X
MA226152207R00000X
CT226152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine