Provider Demographics
NPI:1669506937
Name:GREGORY A GEORGE MD, INC.
Entity Type:Organization
Organization Name:GREGORY A GEORGE MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-347-2955
Mailing Address - Street 1:62 STRAWBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-3234
Mailing Address - Country:US
Mailing Address - Phone:724-347-2955
Mailing Address - Fax:724-347-4664
Practice Address - Street 1:62 STRAWBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3234
Practice Address - Country:US
Practice Address - Phone:724-347-2955
Practice Address - Fax:724-347-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039698L207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35056836OtherSTATE LICENSE
PWMD039698LOtherSTATE LICENSE
OH35056836OtherSTATE LICENSE
PWMD039698LOtherSTATE LICENSE
PA000170797Medicare ID - Type Unspecified