Provider Demographics
NPI:1821051038
Name:BULL, GEOFFREY LATHROP (DO)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:LATHROP
Last Name:BULL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-1460
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 S HERMITAGE RD
Practice Address - Street 2:SUITE B15
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3679
Practice Address - Country:US
Practice Address - Phone:724-983-1355
Practice Address - Fax:724-981-1605
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.004686207P00000X
PAOS007030E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0746394Medicaid
PA047550OtherHIGHMARK BS
OHE97136Medicare UPIN
PA047550OtherHIGHMARK BS