Provider Demographics
NPI:1336140524
Name:HENNAWI, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:HENNAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5601 LOCH RAVEN BLVD
Mailing Address - Street 2:SUITE 412 RUSSELL MORGAN BUILDING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2945
Mailing Address - Country:US
Mailing Address - Phone:443-444-4720
Mailing Address - Fax:443-444-4720
Practice Address - Street 1:5601 LOCH RAVEN
Practice Address - Street 2:RUSSELL MORGAN
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239
Practice Address - Country:US
Practice Address - Phone:443-444-4720
Practice Address - Fax:443-444-4720
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0059479207QG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H85145Medicare UPIN