Provider Demographics
NPI:1366477465
Name:GEORGE, REGINA ACHAMMA (MD)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:ACHAMMA
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 1:54 SCOTT ADAM RD
Mailing Address - Street 2:STE 105
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030
Mailing Address - Country:US
Mailing Address - Phone:410-666-2020
Mailing Address - Fax:410-666-3257
Practice Address - Street 1:54 SCOTT ADAM RD
Practice Address - Street 2:STE 105
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030
Practice Address - Country:US
Practice Address - Phone:410-666-2020
Practice Address - Fax:410-666-3257
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056203208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD269CREOtherBL SHIELD
MD269CREOtherBL SHIELD