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Individual
JOHANNA GEOGHEGAN
Active
Individual
JOHANNA GEOGHEGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA5630
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA5630
PHYSICIAN ASSISTANT LICENSE
MA
Enumeration date
03/15/2016
Last updated
03/15/2016
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