Provider Demographics
NPI:1700852787
Name:AMILO, GEORGE ROBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ROBERT C
Last Name:AMILO
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 1:11 RED FOX CT
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-3204
Mailing Address - Country:US
Mailing Address - Phone:914-907-9538
Mailing Address - Fax:
Practice Address - Street 1:WATERBURY HOSPITAL
Practice Address - Street 2:64 ROBBINS STREET
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-573-6563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1633612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00946621Medicaid
NY10F061Medicare ID - Type Unspecified
NY00946621Medicaid