Provider Demographics
NPI:1942764220
Name:GEORGE, ELIZABETH MARY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARY
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2765 WEATHERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1590
Practice Address - Country:US
Practice Address - Phone:410-328-7943
Practice Address - Fax:410-328-3494
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC07147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant