Provider Demographics
NPI:1508854399
Name:PUEBLITZ, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:PUEBLITZ
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 1:891 MENOHER BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-2839
Mailing Address - Country:US
Mailing Address - Phone:814-539-3119
Mailing Address - Fax:814-539-4137
Practice Address - Street 1:891 MENOHER BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2839
Practice Address - Country:US
Practice Address - Phone:814-539-3119
Practice Address - Fax:814-539-4137
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028921E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009631440002Medicaid
PA674667Medicare PIN
PA0009631440002Medicaid