Provider Demographics
NPI:1760497432
Name:NORTHROP, GEORGE E IV (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:NORTHROP
Suffix:IV
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 1:14 TERRE HAUTE RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7539
Mailing Address - Country:US
Mailing Address - Phone:972-977-8715
Mailing Address - Fax:
Practice Address - Street 1:14 TERRE HAUTE RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:972-977-8715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001436816Medicaid
1760497432OtherNPI
CTI46136Medicare UPIN
CT110009736Medicare PIN