Provider Demographics
NPI:1164429858
Name:GEORGE, CONSTANTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANTINE
Middle Name:
Last Name:GEORGE
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:PO BOX 82227
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89180-2227
Mailing Address - Country:US
Mailing Address - Phone:702-253-5410
Mailing Address - Fax:702-433-5410
Practice Address - Street 1:6252 S RAINBOW BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3248
Practice Address - Country:US
Practice Address - Phone:702-253-5410
Practice Address - Fax:702-433-5410
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11122207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508862Medicaid
NV100506950Medicaid
NV100506950Medicaid
NVV101104Medicare PIN