Provider Demographics
NPI:1558324343
Name:VAZE, GEETA (MD)
Entity Type:Individual
Prefix:
First Name:GEETA
Middle Name:
Last Name:VAZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 WELSH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6357
Mailing Address - Country:US
Mailing Address - Phone:215-947-5151
Mailing Address - Fax:215-947-6858
Practice Address - Street 1:727 WELSH RD
Practice Address - Street 2:STE 101
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6357
Practice Address - Country:US
Practice Address - Phone:215-947-5151
Practice Address - Fax:215-947-6858
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055038L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G15755Medicare UPIN
801456WKIMedicare PIN