Provider Demographics
NPI:1962681098
Name:ATHANASIUS D. GEORGE, M.D., LLC
Entity Type:Organization
Organization Name:ATHANASIUS D. GEORGE, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ATHANASIUS
Authorized Official - Middle Name:DEMOSTHENES
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-916-4500
Mailing Address - Street 1:19735 GERMANTOWN RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1214
Mailing Address - Country:US
Mailing Address - Phone:301-916-4500
Mailing Address - Fax:301-916-6131
Practice Address - Street 1:19735 GERMANTOWN RD
Practice Address - Street 2:SUITE 240
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1214
Practice Address - Country:US
Practice Address - Phone:301-916-4500
Practice Address - Fax:301-916-6131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHANASIUS D. GEORGE, M.D., LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056274207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCF911-0001OtherCAREFIRST BCBS
MD0801568OtherUNITED HEALTHCARE
MD483373OtherMAMSI MD IPA OPT CHOICE
MD61704301OtherCAREFIRST BCBS
MD61704301OtherCAREFIRST BCBS