Provider Demographics
NPI:1255953030
Name:GEOGHEGAN, CORY (DO)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:
Last Name:GEOGHEGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 482 BOX 1600
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96362-0017
Mailing Address - Country:US
Mailing Address - Phone:315-646-7281
Mailing Address - Fax:
Practice Address - Street 1:4494 NORTH PALMER ROAD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5000
Practice Address - Country:US
Practice Address - Phone:301-295-4455
Practice Address - Fax:301-295-5063
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206744207L00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology