Provider Demographics
NPI:1366426181
Name:MCGEEHAN, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MCGEEHAN
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 1:3 W OLIVE ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2572
Mailing Address - Country:US
Mailing Address - Phone:570-969-9575
Mailing Address - Fax:570-969-1651
Practice Address - Street 1:743 JEFFERSON AVE
Practice Address - Street 2:STE. 302
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1635
Practice Address - Country:US
Practice Address - Phone:570-344-9457
Practice Address - Fax:570-343-3731
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD020820E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000770658Medicaid
PA000770658Medicaid
PA150534NW4Medicare ID - Type Unspecified
PA110197529Medicare PIN