Provider Demographics
NPI:1851348718
Name:AVETIAN, GEORGE K (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:K
Last Name:AVETIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:41 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1722
Practice Address - Country:US
Practice Address - Phone:570-846-4777
Practice Address - Fax:570-846-4785
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS004660L207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA028444Medicare ID - Type UnspecifiedPROVIDER NUMBER
PAD98783Medicare UPIN