Provider Demographics
NPI:1689101917
Name:DUFFIELD, GEORGE ALVIN (PA-C)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ALVIN
Last Name:DUFFIELD
Suffix:
Gender:M
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 1:1096 OLD CHURCHMANS RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2102
Mailing Address - Country:US
Mailing Address - Phone:302-655-9494
Mailing Address - Fax:
Practice Address - Street 1:1096 OLD CHURCHMANS RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2102
Practice Address - Country:US
Practice Address - Phone:302-655-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0001159363A00000X
DEC20010015207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma