Provider Demographics
NPI:1528039161
Name:GEORGE, JEANNINE ERIKA (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:ERIKA
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2155
Mailing Address - Street 2:ELLICOTT CITY
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21041-2155
Mailing Address - Country:US
Mailing Address - Phone:410-869-4147
Mailing Address - Fax:410-869-4149
Practice Address - Street 1:3450 ELLICOTT CENTER DR STE 105
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4666
Practice Address - Country:US
Practice Address - Phone:301-905-2334
Practice Address - Fax:410-869-4149
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01417174400000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408339300Medicaid
MD408339300Medicaid
MDV04893Medicare UPIN