Provider Demographics
NPI:1528046562
Name:GEOROFF, MARY E (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:GEOROFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1256 THAYER DR
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-4143
Mailing Address - Country:US
Mailing Address - Phone:336-387-2500
Mailing Address - Fax:336-387-2568
Practice Address - Street 1:706 GREEN VALLEY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7038
Practice Address - Country:US
Practice Address - Phone:336-387-2500
Practice Address - Fax:336-387-2568
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501224207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260797200Medicaid
NC1528046562Medicaid
FL260797200Medicaid
FLE5373ZMedicare PIN
FLE5373XMedicare PIN
FLE5373YMedicare PIN
NCNCP129AMedicare PIN