Provider Demographics
NPI:1558552521
Name:CHAMOUN, GEORGES I (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGES
Middle Name:I
Last Name:CHAMOUN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 JEFFERSON AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1635
Mailing Address - Country:US
Mailing Address - Phone:570-208-0150
Mailing Address - Fax:
Practice Address - Street 1:743 JEFFERSON AVE STE 206
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1635
Practice Address - Country:US
Practice Address - Phone:570-208-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB08260500207V00000X
PAOS016232207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJAMERICHOICEOther010045949
PA1027539530001Medicaid
NJ3423565000OtherAMERIHEALTH/KEYSTONE/IBC
NJ60033436OtherHORIZON NJ HEALTH
NJP3831221OtherOXFORD
NJ1663000OtherAETNA
NJP3831235OtherOXFORD
NJ0141020Medicaid
NJ3K7724OtherHEALTHNET
NJ7076294OtherCIGNA
NJ60033438OtherHORIZON NJ HEALTH
NJ2810528OtherUNITED HEALTHCARE
NJ2810528OtherUNITED HEALTHCARE
NJ1663000OtherAETNA
NJ60033438OtherHORIZON NJ HEALTH