Provider Demographics
NPI:1821094038
Name:GEORGES, ANGELO N (MD)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:N
Last Name:GEORGES
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 1:1 MEDICAL PARK
Mailing Address - Street 2:SUITE 703
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-242-4182
Mailing Address - Fax:304-242-4184
Practice Address - Street 1:1 MEDICAL PARK
Practice Address - Street 2:SUITE 703
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-242-4182
Practice Address - Fax:304-242-4184
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15482207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0042768000Medicaid
PA01817338Medicaid
OH0805614Medicaid
OH0805614Medicaid
OH0617787Medicare PIN
PA01817338Medicaid
OH0617784Medicare PIN