Provider Demographics
NPI:1003838210
Name:IDELKOPE, GEORGE ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ALAN
Last Name:IDELKOPE
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 1:116 PINNACLE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03443-3815
Mailing Address - Country:US
Mailing Address - Phone:603-363-8136
Mailing Address - Fax:
Practice Address - Street 1:68 BRATTLEBORO RD
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:NH
Practice Address - Zip Code:03451
Practice Address - Country:US
Practice Address - Phone:603-336-5948
Practice Address - Fax:603-336-5949
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT6958207P00000X
NH6756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0005673Medicaid
VT00005673OtherBLUE CROSS BLUE SHIELD VT
NH0100563YPNH01OtherANTHEM
NE82080563Medicaid
5777219OtherAETNA
VTVT5673Medicare ID - Type Unspecified
NE82080563Medicaid
VT0005673Medicaid