Provider Demographics
NPI:1790722155
Name:TALIADOUROS, GEORGE S (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:TALIADOUROS
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 1:6000 SAGEMORE DR
Mailing Address - Street 2:SUITE 6102
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3900
Mailing Address - Country:US
Mailing Address - Phone:856-988-0072
Mailing Address - Fax:856-988-7308
Practice Address - Street 1:6000 SAGEMORE DR
Practice Address - Street 2:SUITE 6102
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3900
Practice Address - Country:US
Practice Address - Phone:856-988-0072
Practice Address - Fax:856-988-7308
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA52091207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0165872000OtherAMERIHEALTH
NJ4004108Medicaid
NJ4004108Medicaid
NJ0165872000OtherAMERIHEALTH