Provider Demographics
NPI:1912132325
Name:MAK, GEEBIN (RN, CRNA)
Entity Type:Individual
Prefix:MS
First Name:GEEBIN
Middle Name:
Last Name:MAK
Suffix:
Gender:F
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7816 MULBERRY BOTTOM LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2313
Mailing Address - Country:US
Mailing Address - Phone:310-430-4126
Mailing Address - Fax:
Practice Address - Street 1:1500 THAMES ST
Practice Address - Street 2:UNIT 305
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3443
Practice Address - Country:US
Practice Address - Phone:310-430-4126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001194656163W00000X
MDAC000696163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD025036800Medicaid
MD025036800Medicaid