Provider Demographics
NPI:1609850759
Name:GEORGE, SUSAN V (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:V
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:123 SUMMER ST
Mailing Address - Street 2:STE 7350
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1216
Mailing Address - Country:US
Mailing Address - Phone:508-363-6849
Mailing Address - Fax:508-363-7461
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:STE 7350
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-363-6849
Practice Address - Fax:508-363-7461
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA209762207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0402311OtherEVERCARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTRICARE CHAMPUS
1973721OtherFIRST HEALTH
3643856OtherAETNA US HEALTHCARE
J23362OtherBLUE SHIELD INDEMNITY
9358242OtherCIGNA HEALTH PLAN
110221674OtherRAILROAD MEDICARE
042472266OtherUNITED HEALTHCARE
MA110002708AMedicaid
784020OtherMVP HEALTH CARE
J23362OtherBLUE CARE ELECT
0132373OtherHEALTHY START
042472266OtherTHREE RIVERS
AA2220OtherHARVARD PILGRIM HEALTHCAR
61236OtherFALLON COMMUNITY HEALTH
J23362OtherBLUE SHIELD HMO BLUE
042472266OtherHEALTHCARE VALUE
441341OtherTUFTS HEALTH PLAN
H38614Medicare UPIN
MAMX8728Medicare PIN