Provider Demographics
NPI:1417909243
Name:GEORGE, GREGORY ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ANTHONY
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 1:62 STRAWBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-3234
Mailing Address - Country:US
Mailing Address - Phone:724-347-2955
Mailing Address - Fax:724-347-4664
Practice Address - Street 1:62 STRAWBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3234
Practice Address - Country:US
Practice Address - Phone:724-347-2955
Practice Address - Fax:724-347-4664
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039698L207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010458580008Medicaid
PA0010458580008Medicaid