Provider Demographics
NPI:1215015953
Name:KAMEN, GEOFFREY L (MD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:L
Last Name:KAMEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 E FOOTHILL BLVD # A117
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1615
Mailing Address - Country:US
Mailing Address - Phone:055-961-5658
Mailing Address - Fax:833-428-4062
Practice Address - Street 1:1150 GROVE ST # B
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2914
Practice Address - Country:US
Practice Address - Phone:805-596-1565
Practice Address - Fax:833-428-4062
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2025-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13673207Q00000X
NY240096207QA0000X
CAA115526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA115526OtherMD LICENSE
NH30207759Medicaid
CAA115526OtherMD LICENSE
NHNH2315Medicare PIN
NHRE7915Medicare PIN