Provider Demographics
NPI:1447383864
Name:ESCOBAR, GEORGE MICHAEL (CDOE)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CROSSWYNDS DR
Mailing Address - Street 2:
Mailing Address - City:SAUNDERSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02874-2407
Mailing Address - Country:US
Mailing Address - Phone:401-295-2440
Mailing Address - Fax:
Practice Address - Street 1:7691 POST RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3220
Practice Address - Country:US
Practice Address - Phone:401-295-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI22324-7OtherBLUE CROSS OF RI
RI407595OtherBLUE CHIP OF RI
RI63-00159OtherUNITED HEALTHCARE