Provider Demographics
NPI:1376582700
Name:BACU, GERI LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:GERI
Middle Name:LYNN
Last Name:BACU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:AMBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15003-2335
Mailing Address - Country:US
Mailing Address - Phone:724-266-2447
Mailing Address - Fax:724-266-2920
Practice Address - Street 1:500 MEDICAL ARTS BLDG STE 510
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7137
Practice Address - Country:US
Practice Address - Phone:724-543-8867
Practice Address - Fax:724-545-6466
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049189L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD049189LOtherMD
PAMD049189LOtherMD
PABB3548231OtherDEA