Provider Demographics
NPI:1407859622
Name:MARKWARDT, GEORGE LEE (NP)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:LEE
Last Name:MARKWARDT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CENTRAL PLZ
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-1701
Mailing Address - Country:US
Mailing Address - Phone:315-894-0071
Mailing Address - Fax:315-894-0078
Practice Address - Street 1:55 CENTRAL PLZ
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-1701
Practice Address - Country:US
Practice Address - Phone:315-894-0071
Practice Address - Fax:315-894-0078
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334948363LF0000X
NY460581163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02625285Medicaid
NYQ47228Medicare UPIN