Provider Demographics
NPI:1790728202
Name:AGRITELLIS, GEORGE C (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:C
Last Name:AGRITELLIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3204 TOWER OAKS BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4250
Mailing Address - Country:US
Mailing Address - Phone:301-231-5088
Mailing Address - Fax:301-231-5254
Practice Address - Street 1:121 CONGRESSIONAL LN
Practice Address - Street 2:#510
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1542
Practice Address - Country:US
Practice Address - Phone:301-231-5088
Practice Address - Fax:301-231-5254
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2017-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0056298207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD142701600Medicaid
006078A80Medicare ID - Type Unspecified
MD142701600Medicaid