Provider Demographics
NPI:1245271618
Name:MAYOR, GERALDINE F (MD)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:F
Last Name:MAYOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 CHESTNUT ST APT 601
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3006
Mailing Address - Country:US
Mailing Address - Phone:215-761-9131
Mailing Address - Fax:215-761-9131
Practice Address - Street 1:2201 CHESTNUT ST APT 601
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3006
Practice Address - Country:US
Practice Address - Phone:215-761-9131
Practice Address - Fax:215-761-9131
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067004L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH04878Medicare UPIN
PA073267Medicare ID - Type Unspecified