Provider Demographics
NPI:1861497778
Name:GEFFKEN, DOMINIC F (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:F
Last Name:GEFFKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PLEASANT ST
Mailing Address - Street 2:YEAPLE BUILDING
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7539
Mailing Address - Country:US
Mailing Address - Phone:603-228-7200
Mailing Address - Fax:603-228-7307
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:YEAPLE BUILDING
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-228-7200
Practice Address - Fax:603-228-7307
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12378207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH222594672OtherHEALTHCARE VALUE MANAGE
NH222594672OtherTRICARE
NH222594672OtherUNITED HEALTH CARE
NH4126900OtherMVP HEALTHCARE
NH80300001Medicaid
NH222594672OtherPRIVATE HEALTH CARE
NH222594672OtherGREATWEST HEALTHCARE
NH01YP07636NH01OtherANTHEM
NH2139351OtherCIGNA
NH7445605OtherAETNA
NHAA15532OtherHARVARD PILGRIM
NH222594672OtherGREATWEST HEALTHCARE
NHSX2660Medicare PIN