Provider Demographics
NPI:1275821340
Name:BULLOCK, GERANAMEO VLADMIRE (MD)
Entity Type:Individual
Prefix:
First Name:GERANAMEO
Middle Name:VLADMIRE
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GERANAMEO
Other - Middle Name:VLADIMIR
Other - Last Name:BULLOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2872 E POINT DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-4125
Mailing Address - Country:US
Mailing Address - Phone:347-794-3761
Mailing Address - Fax:757-800-3274
Practice Address - Street 1:2872 E POINT DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-4125
Practice Address - Country:US
Practice Address - Phone:347-794-3761
Practice Address - Fax:757-800-3274
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012535132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry