Provider Demographics
NPI:1376688531
Name:GERACIMOS, RYAN TYLER (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:TYLER
Last Name:GERACIMOS
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 1:200 S BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5915
Mailing Address - Country:US
Mailing Address - Phone:410-620-1900
Mailing Address - Fax:
Practice Address - Street 1:200 S BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5915
Practice Address - Country:US
Practice Address - Phone:410-620-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00075872085R0202X
MDD662922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology