Provider Demographics
NPI:1457452930
Name:ANTONY M GEORGE MD & ASSOCIATES LLC
Entity Type:Organization
Organization Name:ANTONY M GEORGE MD & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-944-2863
Mailing Address - Street 1:28080 CHARDON RD STE 04
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-3000
Mailing Address - Country:US
Mailing Address - Phone:440-944-2863
Mailing Address - Fax:440-944-2697
Practice Address - Street 1:28080 CHARDON RD STE 04
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-3000
Practice Address - Country:US
Practice Address - Phone:440-944-2863
Practice Address - Fax:440-944-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-064060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9322392Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER