Provider Demographics
NPI:1508188434
Name:GEORGE H. SACK, JR LLC
Entity Type:Organization
Organization Name:GEORGE H. SACK, JR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SACK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-735-6605
Mailing Address - Street 1:5801 SMITH AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3652
Mailing Address - Country:US
Mailing Address - Phone:410-735-6605
Mailing Address - Fax:
Practice Address - Street 1:5801 SMITH AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3652
Practice Address - Country:US
Practice Address - Phone:410-735-6605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD13190170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty