Provider Demographics
NPI:1629061486
Name:JOBSON, GEORGE WMARK (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WMARK
Last Name:JOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MARYS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5849
Mailing Address - Country:US
Mailing Address - Phone:845-338-0050
Mailing Address - Fax:845-331-1996
Practice Address - Street 1:117 MARYS AVE STE 101
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5849
Practice Address - Country:US
Practice Address - Phone:845-338-0050
Practice Address - Fax:845-331-1996
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166060207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01170369Medicaid
NY9X5471Medicare PIN
NY01170369Medicaid