Provider Demographics
NPI:1730808460
Name:GEYER, MIRANDA LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LOUISE
Last Name:GEYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:LOUISE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 N HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-1304
Mailing Address - Country:US
Mailing Address - Phone:717-381-5207
Mailing Address - Fax:
Practice Address - Street 1:146 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-1964
Practice Address - Country:US
Practice Address - Phone:717-656-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA063873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine