Provider Demographics
NPI:1639298342
Name:GEOFFROY, REBECCA (PA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GEOFFROY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5308
Mailing Address - Country:US
Mailing Address - Phone:413-442-8267
Mailing Address - Fax:413-442-8253
Practice Address - Street 1:426 EAST ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5308
Practice Address - Country:US
Practice Address - Phone:413-442-8267
Practice Address - Fax:413-442-8253
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2076363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical