Provider Demographics
NPI:1518938646
Name:GEISSEN, CORNELIUS MARVIN (DO)
Entity Type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:MARVIN
Last Name:GEISSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 MEDICAL DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3292
Mailing Address - Country:US
Mailing Address - Phone:484-945-0405
Mailing Address - Fax:484-945-0379
Practice Address - Street 1:555 GLASGOW ST
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:PA
Practice Address - Zip Code:19464-6557
Practice Address - Country:US
Practice Address - Phone:484-945-0770
Practice Address - Fax:484-945-0648
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004823L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00069267Medicare PIN
72081Medicare ID - Type Unspecified
D72398Medicare UPIN