Provider Demographics
NPI:1609861194
Name:GEARY, JOHN A (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:GEARY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 HIGHLAND ST
Mailing Address - Street 2:ATTN K BOYER CPA
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3800
Mailing Address - Country:US
Mailing Address - Phone:617-696-4600
Mailing Address - Fax:781-986-5801
Practice Address - Street 1:100 HIGHLAND ST
Practice Address - Street 2:STE 125
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3881
Practice Address - Country:US
Practice Address - Phone:617-696-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S38612Medicare UPIN
MAPA0333Medicare ID - Type Unspecified