Provider Demographics
NPI:1174499040
Name:KALATHIL GEORGE, JISHA
Entity type:Individual
Prefix:
First Name:JISHA
Middle Name:
Last Name:KALATHIL GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E SHAKESPEARE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1651
Mailing Address - Country:US
Mailing Address - Phone:302-545-6231
Mailing Address - Fax:
Practice Address - Street 1:12 E SHAKESPEARE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1651
Practice Address - Country:US
Practice Address - Phone:302-545-6231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program