Provider Demographics
NPI:1770821969
Name:GATES, GEORGE MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:MATTHEW
Last Name:GATES
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 1:3 POND DR
Mailing Address - Street 2:
Mailing Address - City:LLOYD HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1718
Mailing Address - Country:US
Mailing Address - Phone:631-421-2290
Mailing Address - Fax:
Practice Address - Street 1:3 POND DR
Practice Address - Street 2:
Practice Address - City:LLOYD HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11743-1718
Practice Address - Country:US
Practice Address - Phone:631-421-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164500207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology