Provider Demographics
NPI:1588678379
Name:ANTONY M GEORGE MD MPH LLC
Entity Type:Organization
Organization Name:ANTONY M GEORGE MD MPH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-403-9506
Mailing Address - Street 1:18660 BAGLEY RD STE 200B
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-8408
Mailing Address - Country:US
Mailing Address - Phone:440-403-9506
Mailing Address - Fax:440-403-9507
Practice Address - Street 1:18660 BAGLEY RD STE 200B
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-8408
Practice Address - Country:US
Practice Address - Phone:440-403-9506
Practice Address - Fax:440-403-9507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9322392Medicare PIN