Individual
GEOFFREY S. FASEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2945 HAZELWOOD ST STE 100, MAPLEWOOD, MN 55109-1242
(651) 227-6351
(651) 227-1134
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101258324
VA
208600000X
Surgery Physician
54101
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/14/2010
Last updated
01/15/2020
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