Provider Demographics
NPI:1336142132
Name:HARTER, GEOFFREY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:THOMAS
Last Name:HARTER
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 1:1234 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4606
Mailing Address - Country:US
Mailing Address - Phone:540-345-1561
Mailing Address - Fax:540-343-6012
Practice Address - Street 1:1234 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4606
Practice Address - Country:US
Practice Address - Phone:540-345-1561
Practice Address - Fax:540-343-6012
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044826174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010358825Medicaid
VAC65013Medicare UPIN