Provider Demographics
NPI:1689791287
Name:GEORGE, CLAUDENE JESSIE (MD, RPH)
Entity Type:Individual
Prefix:DR
First Name:CLAUDENE
Middle Name:JESSIE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD, RPH
Other - Prefix:DR
Other - First Name:CLAUDENE
Other - Middle Name:GEORGE
Other - Last Name:BACON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, RPH
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2490
Mailing Address - Country:US
Mailing Address - Phone:866-633-8255
Mailing Address - Fax:718-655-8255
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2490
Practice Address - Country:US
Practice Address - Phone:866-633-8255
Practice Address - Fax:718-655-8255
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236441207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine