Provider Demographics
NPI: | 1831112705 |
---|---|
Name: | SARRIS, GEORGE A (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | GEORGE |
Middle Name: | A |
Last Name: | SARRIS |
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: | 3920A BRIDGE RD |
Mailing Address - Street 2: | STE 202 |
Mailing Address - City: | SUFFOLK |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23435-1107 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-983-0330 |
Mailing Address - Fax: | 757-431-7788 |
Practice Address - Street 1: | 5838 HARBOUR VIEW BLVD |
Practice Address - Street 2: | SUTE 270 |
Practice Address - City: | SUFFOLK |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23435-2663 |
Practice Address - Country: | US |
Practice Address - Phone: | 757-541-1050 |
Practice Address - Fax: | 757-541-1097 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-25 |
Last Update Date: | 2019-12-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0101231293 | 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 5859557 | Medicaid | |
VA | 5859557 | Medicaid | |
VA | G65288 | Medicare UPIN | |
VA | C10680 | Medicare PIN | |
VA | C01491 | Medicare ID - Type Unspecified | MEDICARE GROUP ID # |