Provider Demographics
NPI:1538383427
Name:GEOHAGEN, MADGE H (PA-C)
Entity type:Individual
Prefix:MS
First Name:MADGE
Middle Name:H
Last Name:GEOHAGEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8580 ANDOVER BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8382
Mailing Address - Country:US
Mailing Address - Phone:407-275-1943
Mailing Address - Fax:407-275-1943
Practice Address - Street 1:7600 DR PHILLIPS BLVD
Practice Address - Street 2:SUITE 58
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7231
Practice Address - Country:US
Practice Address - Phone:407-226-0609
Practice Address - Fax:407-226-0610
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102699363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant