Provider Demographics
NPI:1710966098
Name:RECORD, GEORGE TITTMANN (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:TITTMANN
Last Name:RECORD
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 1:206 JENNY LYNN EST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4821
Mailing Address - Country:US
Mailing Address - Phone:860-601-8420
Mailing Address - Fax:304-291-0901
Practice Address - Street 1:341 SPRUCE ST
Practice Address - Street 2:MILAN PUSKAR HEALTH RIGHT
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5504
Practice Address - Country:US
Practice Address - Phone:304-292-8234
Practice Address - Fax:304-284-0133
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT28630208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
028630OtherCONNECTICARE
3487054OtherAETNA
WV1710966098OtherMT ST BCBS #
WV3810016952Medicaid
CT001286302Medicaid
2V4659OtherHEALTHNET
CT001286302-02OtherBLUECARE FAMILY PLAN (MCD
CT010018270CT04OtherANTHEM BC/BS
CT001286302-02OtherBLUECARE FAMILY PLAN (MCD
CT010018270CT04OtherANTHEM BC/BS