Provider Demographics
NPI:1821099011
Name:SMALL, GEORGE A (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:SMALL
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 1:490 E NORTH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4765
Mailing Address - Country:US
Mailing Address - Phone:412-359-8860
Mailing Address - Fax:412-359-8809
Practice Address - Street 1:490 E NORTH AVE STE 500
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4765
Practice Address - Country:US
Practice Address - Phone:412-359-8860
Practice Address - Fax:412-359-8809
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049217L2084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001408650Medicaid
10936641OtherCAQH
WV0207808000Medicaid
WV0207808000Medicaid
OH2241327Medicaid
PA0014086500001Medicaid