Provider Demographics
NPI:1134126204
Name:GEORGE, PATRICK L (PA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:L
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1433
Mailing Address - Country:US
Mailing Address - Phone:716-834-3278
Mailing Address - Fax:716-862-9342
Practice Address - Street 1:1616 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1433
Practice Address - Country:US
Practice Address - Phone:716-834-3278
Practice Address - Fax:716-862-9342
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0052291363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02057165Medicaid
NY02057165Medicaid
NYAA0808Medicare ID - Type Unspecified