Provider Demographics
NPI:1407878713
Name:MCGEEHAN, PAUL A (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:MCGEEHAN
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 1:11487 SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-3143
Mailing Address - Country:US
Mailing Address - Phone:814-725-9800
Mailing Address - Fax:814-725-9800
Practice Address - Street 1:612 W SMITH ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1152
Practice Address - Country:US
Practice Address - Phone:814-665-1977
Practice Address - Fax:814-665-1977
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031177E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1074617Medicaid
PA432693QFPMedicare ID - Type Unspecified
PA1074617Medicaid