Provider Demographics
NPI:1982677829
Name:POKORNY, GEORGE ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ROY
Last Name:POKORNY
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:PO BOX 3011
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-3011
Mailing Address - Country:US
Mailing Address - Phone:518-626-5000
Mailing Address - Fax:518-626-6558
Practice Address - Street 1:113 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3410
Practice Address - Country:US
Practice Address - Phone:518-626-5000
Practice Address - Fax:518-626-6558
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156399207X00000X
GA067744207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129932AMedicaid
PA0011829460001Medicaid
GAGA1426OtherSC MEDICAID
NY00965637Medicaid
PA0011829460001Medicaid
GAGA1426OtherSC MEDICAID