Provider Demographics
NPI:1609843309
Name:MOUTSATSOS, GEORGE D (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:D
Last Name:MOUTSATSOS
Suffix:
Gender:M
Credentials:MD
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 829641
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0001
Mailing Address - Country:US
Mailing Address - Phone:267-370-5295
Mailing Address - Fax:215-230-3725
Practice Address - Street 1:1650 HUNTINGDON PIKE STE 258
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8008
Practice Address - Country:US
Practice Address - Phone:215-918-1550
Practice Address - Fax:215-938-1342
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006169207RC0000X
PAMD068517L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001091101Medicaid
DE0001091101Medicaid
DE006917C16Medicare PIN