Provider Demographics
NPI:1326064684
Name:GEORGETTI, DEBRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:S
Last Name:GEORGETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 VIEWMONT DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1664
Mailing Address - Country:US
Mailing Address - Phone:570-346-1464
Mailing Address - Fax:
Practice Address - Street 1:920 VIEWMONT DRIVE
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1683
Practice Address - Country:US
Practice Address - Phone:570-346-1464
Practice Address - Fax:570-346-7450
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063076-L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1709519Medicaid
800989Medicare UPIN