Provider Demographics
NPI:1154315562
Name:CONNORS, GEORGE L (PA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:L
Last Name:CONNORS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1 COMMERCE ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1168
Mailing Address - Country:US
Mailing Address - Phone:401-793-8500
Mailing Address - Fax:401-793-8511
Practice Address - Street 1:1 COMMERCE ST
Practice Address - Street 2:2ND FL
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1168
Practice Address - Country:US
Practice Address - Phone:401-793-8500
Practice Address - Fax:401-793-8511
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIPA000051363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIS66030Medicare UPIN
RI0070098541Medicare PIN