Provider Demographics
NPI:1902830888
Name:MATHEW, GEORGE M (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:M
Last Name:MATHEW
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 1:732 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4442
Mailing Address - Country:US
Mailing Address - Phone:352-728-2532
Mailing Address - Fax:352-728-3004
Practice Address - Street 1:732 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4442
Practice Address - Country:US
Practice Address - Phone:352-728-2532
Practice Address - Fax:352-728-3004
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME22451207R00000X, 207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056386200Medicaid
FL061907211OtherRAILROAD MEDICARE
FL35134OtherBCBS
FL35134OtherBCBS
D54329Medicare UPIN