Provider Demographics
NPI:1275187361
Name:GEORGE, PETER RUDOLPH
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:RUDOLPH
Last Name:GEORGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 E DAWNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2408
Mailing Address - Country:US
Mailing Address - Phone:216-210-3447
Mailing Address - Fax:
Practice Address - Street 1:557 E DAWNWOOD DR
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-2408
Practice Address - Country:US
Practice Address - Phone:216-210-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health