Provider Demographics
NPI:1578583902
Name:GEFFIN, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:GEFFIN
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 1:910 WASHINGTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6022
Mailing Address - Country:US
Mailing Address - Phone:781-762-0471
Mailing Address - Fax:781-762-8072
Practice Address - Street 1:51 OBERY ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2129
Practice Address - Country:US
Practice Address - Phone:978-927-0714
Practice Address - Fax:978-927-9135
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203268208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0158020Medicaid
H19608Medicare UPIN
MAA31280Medicare ID - Type Unspecified