Provider Demographics
NPI:1558366427
Name:SIMON, GEOFFREY R (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:R
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:795 E MARSHALL ST
Mailing Address - Street 2:SUITE 301-307
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4400
Mailing Address - Country:US
Mailing Address - Phone:610-429-1100
Mailing Address - Fax:610-429-4848
Practice Address - Street 1:795 E MARSHALL ST
Practice Address - Street 2:SUITE 301-307
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4400
Practice Address - Country:US
Practice Address - Phone:610-429-1100
Practice Address - Fax:610-429-4848
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA041485208000000X
DEC10010179208000000X
PAMD458449208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA041485OtherSTATE MEDICAL LICENSE #
DEC10010179OtherSTATE LICENSE NUMBER