Provider Demographics
NPI:1861627994
Name:GAVRILA, GEORGE O (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:O
Last Name:GAVRILA
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 1:29 S PACA ST
Mailing Address - Street 2:FAMILY MEDICINE, LOWER LEVEL
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1771
Mailing Address - Country:US
Mailing Address - Phone:410-328-5012
Mailing Address - Fax:410-328-0639
Practice Address - Street 1:29 S PACA ST
Practice Address - Street 2:FAMILY MEDICINE, LOWER LEVEL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1771
Practice Address - Country:US
Practice Address - Phone:410-328-5012
Practice Address - Fax:410-328-0639
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program