Provider Demographics
NPI:1942234208
Name:GEORGE, SABU (MD, FACC)
Entity Type:Individual
Prefix:
First Name:SABU
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:SABU
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, FACC
Mailing Address - Street 1:13106 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1604
Mailing Address - Country:US
Mailing Address - Phone:215-677-5431
Mailing Address - Fax:
Practice Address - Street 1:234 MILL ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-4809
Practice Address - Country:US
Practice Address - Phone:215-785-5100
Practice Address - Fax:215-785-5101
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071538L207R00000X, 207RC0000X
WI71574207RI0011X
NE31961207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1851521OtherHIGHMARK
PA2708321000OtherINDEPENDENCE BLUE CROSS
PA101648757Medicaid
PA30043356OtherKEYSTONE MERCY
PA101648757Medicaid
PA1851521OtherHIGHMARK