Provider Demographics
NPI:1942476114
Name:MCKAY, GEORGE R (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:MCKAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-967-8622
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:2800 GODWIN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8038
Practice Address - Country:US
Practice Address - Phone:757-967-8622
Practice Address - Fax:757-686-0541
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203717207R00000X, 208M00000X
PAOT011339207R00000X
NC2008-01696207R00000X
PAOS014324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910844Medicaid
NC151AEOtherBCBSNC
NC5910844Medicaid