Provider Demographics
NPI:1134174147
Name:ST GEORGE, CAROL LINDA (DO)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LINDA
Last Name:ST GEORGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1776 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4628
Practice Address - Country:US
Practice Address - Phone:717-845-6261
Practice Address - Fax:717-852-0630
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004419L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1338861OtherHIGHMARK BLUE SHIELD
PA01564701OtherCAPITAL BLUE CROSS
PA9788350005Medicaid
PA1338861OtherHIGHMARK BLUE SHIELD
PA01564701OtherCAPITAL BLUE CROSS