Provider Demographics
NPI:1649607128
Name:AARON J GESWALDO DO PC
Entity type:Organization
Organization Name:AARON J GESWALDO DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:GESWALDO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:505-221-6140
Mailing Address - Street 1:4901 LANG AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4495
Mailing Address - Country:US
Mailing Address - Phone:505-221-6140
Mailing Address - Fax:505-214-5315
Practice Address - Street 1:8100 WYOMING BLVD NE
Practice Address - Street 2:SUITE M4 #357
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1946
Practice Address - Country:US
Practice Address - Phone:505-221-6140
Practice Address - Fax:505-214-5315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA132505208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty