Provider Demographics
NPI:1942482245
Name:GEORGE, NOBLE (MD)
Entity Type:Individual
Prefix:
First Name:NOBLE
Middle Name:
Last Name:GEORGE
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 1:4 NESHAMINY INTERPLEX
Mailing Address - Street 2:SUITE 209
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6940
Mailing Address - Country:US
Mailing Address - Phone:215-244-3070
Mailing Address - Fax:215-638-9041
Practice Address - Street 1:3998 RED LION ROAD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4385162085R0202X, 207U00000X, 2085N0904X
NJ25MA086956002085R0202X, 207U00000X, 2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0226840Medicaid
PA102398695-0001Medicaid
PAP00794131OtherRAILROAD MEDICARE
NJP00827140OtherRAILROAD MEDICARE
NJ180477VSBMedicare PIN
PA102398695-0001Medicaid