Provider Demographics
NPI:1063445179
Name:WHITESQUARE VASCULAR SURGERY PA
Entity Type:Organization
Organization Name:WHITESQUARE VASCULAR SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JABAJI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:410-682-4433
Mailing Address - Street 1:9114 PHILADELPHIA ROAD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237
Mailing Address - Country:US
Mailing Address - Phone:410-682-4433
Mailing Address - Fax:410-682-4051
Practice Address - Street 1:9114 PHILADELPHIA ROAD
Practice Address - Street 2:SUITE 308
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:410-682-4433
Practice Address - Fax:410-682-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD708LMedicare PIN
MDB66815Medicare UPIN