Provider Demographics
NPI:1518995661
Name:GEORGE, GRACE T (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:T
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:95 GRASSLANDS ROAD
Mailing Address - Street 2:UNIVERSITY IMAGING AND MEDICAL ASSC. PC
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-493-8881
Mailing Address - Fax:914-493-1195
Practice Address - Street 1:95 GRASSLANDS ROAD
Practice Address - Street 2:UNIVERSITY IMAGING AND MEDICAL ASSC. PC
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-8881
Practice Address - Fax:914-493-1195
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1591632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00957502Medicaid
NY00957502Medicaid
NY89D891Medicare ID - Type Unspecified