Provider Demographics
NPI:1265657464
Name:KASOTAKIS, GEORGE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:KASOTAKIS
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:
Other - Last Name:KASOTAKIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:DUKE UNIVERSITY MEDICAL CENTER DUMC 2837 2301 ERWIN RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8260 WILLOW OAKS CORPORATE DR STE 600
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4528
Practice Address - Country:US
Practice Address - Phone:571-472-4670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA243298208600000X, 2086S0102X
NC2018-021842086S0127X
VA01012782972086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110088684AMedicaid
MA110088684AMedicaid
MA002192203Medicare PIN