Provider Demographics
NPI:1891775367
Name:ELIAS, GEORGE N (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:N
Last Name:ELIAS
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 1:45 SUMMERLAND CIR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1628
Mailing Address - Country:US
Mailing Address - Phone:949-633-2862
Mailing Address - Fax:419-229-0040
Practice Address - Street 1:45 SUMMERLAND CIR
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-1628
Practice Address - Country:US
Practice Address - Phone:949-633-2862
Practice Address - Fax:419-229-0040
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH37.0773342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2436957Medicaid
CA00A858460Medicaid
OHEL4012359Medicare ID - Type Unspecified
OH2436957Medicaid
CAWA85846IMedicare PIN