Provider Demographics
NPI:1235115270
Name:GEIGER, CHARLES LEWIS (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LEWIS
Last Name:GEIGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1363
Mailing Address - Country:US
Mailing Address - Phone:220-564-1770
Mailing Address - Fax:220-564-1771
Practice Address - Street 1:1970 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1363
Practice Address - Country:US
Practice Address - Phone:220-564-1770
Practice Address - Fax:220-564-1771
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1932207Q00000X
OH34007833G207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2324916Medicaid
OH2324916Medicaid
OH7301391Medicare PIN
WVGE4081041Medicare ID - Type Unspecified
WV2003183000Medicaid