Provider Demographics
NPI:1457643272
Name:GEESLIN, MATTHEW G (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:GEESLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVENUE
Mailing Address - Street 2:UVM MEDICAL CENTER, DEPT. OF RADIOLOGY
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-847-2030
Mailing Address - Fax:802-847-8493
Practice Address - Street 1:111 COLCHESTER AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-2030
Practice Address - Fax:802-847-8493
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012539042085R0202X
VT042.00138642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology