Provider Demographics
NPI:1528028297
Name:BONE, GEORGE HERBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HERBERT
Last Name:BONE
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 1:1100 MERCANTILE LN
Mailing Address - Street 2:SUITE 135
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5380
Mailing Address - Country:US
Mailing Address - Phone:301-773-9700
Mailing Address - Fax:301-773-4900
Practice Address - Street 1:1100 MERCANTILE LN
Practice Address - Street 2:SUITE 135
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5380
Practice Address - Country:US
Practice Address - Phone:301-773-9700
Practice Address - Fax:301-773-4900
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD31069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
58610001OtherCARE FIRST BCBS
C89226Medicare UPIN
MD473760Medicare ID - Type Unspecified
MD409341100Medicaid
820496OtherMDIPA