Provider Demographics
NPI:1508911355
Name:NIEDERMAYER, GEORGE HUNTAS (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HUNTAS
Last Name:NIEDERMAYER
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 1:711 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4006
Mailing Address - Country:US
Mailing Address - Phone:215-627-2122
Mailing Address - Fax:215-627-2618
Practice Address - Street 1:711 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4006
Practice Address - Country:US
Practice Address - Phone:215-627-2122
Practice Address - Fax:215-627-2618
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD006847E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB32430Medicare UPIN