Provider Demographics
NPI:1932247657
Name:GERACI, ANTHONY CHARLES (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CHARLES
Last Name:GERACI
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 1:45 BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-5602
Mailing Address - Country:US
Mailing Address - Phone:843-458-7658
Mailing Address - Fax:678-222-0122
Practice Address - Street 1:45 BIRCH LN
Practice Address - Street 2:SUITE 500
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-5602
Practice Address - Country:US
Practice Address - Phone:843-361-1513
Practice Address - Fax:678-222-0122
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000429207R00000X
TN2598207R00000X
NY275402207R00000X
MEDO2395207R00000X
AZ006151207R00000X
GA048897207R00000X
IADO-04593207R00000X
MDH79069207R00000X
VA0102201173207R00000X
MO2014031322207R00000X
WY9463A207R00000X
SC529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903346Medicaid
SC005292Medicaid
SCF803367762Medicare PIN
SC005292Medicaid
NCNC4475AMedicare PIN