Provider Demographics
NPI:1477554293
Name:CAVANAGH, GEORGE BRINTON (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BRINTON
Last Name:CAVANAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:4201 MITCHELLVILLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3163
Practice Address - Country:US
Practice Address - Phone:301-262-5900
Practice Address - Fax:410-741-0865
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0031602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0472812OtherAETNA CAPITATED
MD4339374OtherAETNA FEE FOR SERVICE
MD235426OtherMAMSI SPECIALIST
MD1370929OtherCIGNA PIN
MD835426OtherMAMSI PRIMARY CARE
MD013140OtherJHHC PROVIDER NUMBER
MD080113969OtherRAILROAD MEDICARE
MD411788-01OtherCAREFIRST MD RENDERING
MDP11957OtherCAREFIRST MPOS
MD401571100Medicaid
MD7605-0027OtherCAREFIRST BLUECHOICE
MD7605-0027OtherCAREFIRST BLUECHOICE
MDG00114000F19M14Medicare PIN