Provider Demographics
NPI:1114980570
Name:GEORGEVICH, PHILIP G (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:G
Last Name:GEORGEVICH
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 1:27 HECKEL RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1616
Mailing Address - Country:US
Mailing Address - Phone:412-777-4332
Mailing Address - Fax:412-777-4310
Practice Address - Street 1:27 HECKEL RD
Practice Address - Street 2:SUITE 206
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1616
Practice Address - Country:US
Practice Address - Phone:412-777-4332
Practice Address - Fax:412-777-4310
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027326E208600000X, 208C00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA093038Medicare PIN
PAB42042Medicare UPIN