Provider Demographics
NPI:1518073170
Name:GEARAN, THOMAS P
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:GEARAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:5 BUCKNAM RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1208
Practice Address - Country:US
Practice Address - Phone:207-781-1600
Practice Address - Fax:207-781-1609
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD16839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431894299Medicaid
MEI12704Medicare UPIN
MEP00928543Medicare PIN
MEME141802Medicare PIN
MEME1418Medicare PIN
MEP01213781Medicare PIN
MEME141801Medicare PIN
MEP00250408Medicare PIN