Provider Demographics
NPI:1336190032
Name:TEMPLE, GEOFFREY W (DO)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:W
Last Name:TEMPLE
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 1:2494 WASHINGTON LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-5922
Mailing Address - Country:US
Mailing Address - Phone:215-938-1712
Mailing Address - Fax:
Practice Address - Street 1:2834 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1433
Practice Address - Country:US
Practice Address - Phone:215-624-6162
Practice Address - Fax:215-624-2496
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005686-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0058184000OtherKEYSTONE HMO
PA1218573OtherAETNA
PA407678OtherHIGHMARK
PA407678OtherHIGHMARK
PAE70781Medicare UPIN