Provider Demographics
NPI:1639105414
Name:AGRONS, GEOFFREY A (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:A
Last Name:AGRONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 HUDSON DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4451
Mailing Address - Country:US
Mailing Address - Phone:330-655-3800
Mailing Address - Fax:
Practice Address - Street 1:5655 HUDSON DR
Practice Address - Street 2:SUITE 210
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4451
Practice Address - Country:US
Practice Address - Phone:330-655-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039076E2085P0229X, 2085R0202X
DEC100102542085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016538430002Medicaid
MA254125OtherMEDICAL LICENSE
CAG88955OtherMEDICAL LICENSE
FLME1151141OtherMEDICAL LICENSE
VA0101253162OtherMEDICAL LICENSE
IL036131677OtherMEDICAL LICENSE
NE27097OtherMEDICAL LICENSE
PAMD039076-EOtherMEDICAL LICENSE
DEC1-0010254OtherMEDICAL LICENSE
CODR0051856OtherMEDICAL LICENSE
DCMD041151OtherMEDICAL LICENSE
NY267567OtherMEDICAL LICENSE
KY45821OtherMEDICAL LICENSE
AZ46950OtherMEDICAL LICENSE
MDD0075056OtherMEDICAL LICENSE
KS04-36063OtherMEDICAL LICENSE
MO2012032350OtherMEDICAL LICENSE
NY267567OtherMEDICAL LICENSE
MDD0075056OtherMEDICAL LICENSE