Provider Demographics
NPI:1205942877
Name:GEARAN, TEVIS H (MD)
Entity type:Individual
Prefix:
First Name:TEVIS
Middle Name:H
Last Name:GEARAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TEVIS
Other - Middle Name:
Other - Last Name:HATCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:301 US ROUTE 1
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7609
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:5 BUCKNAM RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1392
Practice Address - Country:US
Practice Address - Phone:207-662-1622
Practice Address - Fax:207-774-1814
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD16831207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431900699Medicaid
MEP00965332Medicare PIN
MEME1554Medicare PIN
ME431900699Medicaid
MEME155402Medicare PIN
MEME155401Medicare PIN
MEI00561Medicare UPIN
MEP01214345Medicare PIN