Provider Demographics
NPI:1275543001
Name:GEORGE, MARIADA (MD)
Entity Type:Individual
Prefix:
First Name:MARIADA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S COULTER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1787
Mailing Address - Country:US
Mailing Address - Phone:806-354-0404
Mailing Address - Fax:806-354-2810
Practice Address - Street 1:1500 S COULTER ST STE 1
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1787
Practice Address - Country:US
Practice Address - Phone:806-354-0404
Practice Address - Fax:806-354-2810
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1325208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113453100OtherFIRST CARE
TX144209701Medicaid
TX081138202Medicaid
TX8B5400OtherBCBS
TX113453100OtherSOUTHWEST LIFE & HEALTH
8467NOMedicare PIN