Provider Demographics
NPI:1790763340
Name:GERALDS, BETH A (PA-C)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:GERALDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PLEASANT ST
Mailing Address - Street 2:EMERGENCY DEPT
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7539
Mailing Address - Country:US
Mailing Address - Phone:603-225-7000
Mailing Address - Fax:603-230-7218
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-225-7000
Practice Address - Fax:603-230-7218
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-001731363A00000X
NH0806363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30338609Medicaid
NH30338609Medicaid
NH0022261Medicare PIN
P36396Medicare UPIN