Provider Demographics
NPI:1275549404
Name:GEORGEOFF, RICHARD M (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:GEORGEOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 SHELBY AVE W
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8637
Mailing Address - Country:US
Mailing Address - Phone:614-370-6960
Mailing Address - Fax:614-766-6960
Practice Address - Street 1:386 SHELBY AVE W
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8637
Practice Address - Country:US
Practice Address - Phone:614-370-6960
Practice Address - Fax:614-766-6960
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36. 002395213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0665721Medicaid
OHGE0595342Medicare ID - Type UnspecifiedMEDICARE
OH0665721Medicaid