Provider Demographics
NPI:1366443541
Name:GEORGE, ANTONY M (MD)
Entity Type:Individual
Prefix:
First Name:ANTONY
Middle Name:M
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20575 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3422
Mailing Address - Country:US
Mailing Address - Phone:440-403-9506
Mailing Address - Fax:440-403-9507
Practice Address - Street 1:20575 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3422
Practice Address - Country:US
Practice Address - Phone:440-403-9506
Practice Address - Fax:440-403-9507
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350640602083S0010X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0993368Medicaid
OH0772268Medicare PIN
OHE49835Medicare UPIN
4217811Medicare PIN