Provider Demographics
NPI:1184813792
Name:GEH MEDICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:GEH MEDICAL ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:N
Authorized Official - Last Name:GEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-225-8620
Mailing Address - Street 1:PO BOX 1280
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21041-1280
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 ARMORY PL
Practice Address - Street 2:SUITE 3G
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4603
Practice Address - Country:US
Practice Address - Phone:410-225-8620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
04-04411OtherUNITED HEALTHCARE
LW11GEOtherCAREFIRST BC/BS
2745223OtherAETNA HEALTH PLAN
2783OtherELDERHEALTH
MDFO81OtherCAREFIRST BLUE CHOICE
MD007201000Medicaid
MD022803OtherPRIORITY PARTNERS
MD298110OtherMAMSI HEALTH
MD007201000Medicaid
LW11GEOtherCAREFIRST BC/BS
04-04411OtherUNITED HEALTHCARE