Provider Demographics
NPI:1952317745
Name:PANAGIOTIDES, GEORGE P (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:P
Last Name:PANAGIOTIDES
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Gender:M
Credentials:MD, FACS
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Mailing Address - Street 1:3650 SOUTH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1502
Mailing Address - Country:US
Mailing Address - Phone:562-531-0019
Mailing Address - Fax:562-531-0032
Practice Address - Street 1:3650 SOUTH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1502
Practice Address - Country:US
Practice Address - Phone:562-531-0019
Practice Address - Fax:562-531-0032
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2014-09-25
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Provider Licenses
StateLicense IDTaxonomies
CAG73503208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
G04023Medicare UPIN