Provider Demographics
NPI:1689002834
Name:GEORGE, MAGGIE L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MAGGIE
Middle Name:L
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-510-6200
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260020832255A2300X
VA0110005514363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1689002834OtherMEDICAID QMB
VA1689002834OtherAETNA
VA1OtherUNITED MINE WORKERS ASSOCIATION
VA1OtherANTHEM MEDIGAP
VA1689002834OtherTRICARE
VA1689002834OtherMAGELLAN CCP
VA1689002834OtherINTOTAL
VA1689002834OtherCCCP VIRGINIA PREMIER
VA1OtherHUMANA MEDICARE
VA1689002834OtherOPTIMA HEALTH PLAN
VA1689002834OtherCOVENTRY/AETNA BETTER HEALTH