Provider Demographics
NPI:1750379376
Name:COUSINS, GEOFFREY R (MD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:R
Last Name:COUSINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:200 POCAHONTAS TRAIL
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-0088
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5031
Practice Address - Street 1:2828 1ST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1236
Practice Address - Country:US
Practice Address - Phone:304-399-7530
Practice Address - Fax:304-399-7532
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2022-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WVWV21957208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003749Medicaid
OH2927622Medicaid
WV001766919OtherBCBS
WVI34444Medicare UPIN
WV001766919OtherBCBS