Provider Demographics
NPI:1134253099
Name:VITERBO, GEORGE QUENTIN GREGORIO (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE QUENTIN
Middle Name:GREGORIO
Last Name:VITERBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2101 FOULK RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4710
Mailing Address - Country:US
Mailing Address - Phone:302-475-2535
Mailing Address - Fax:302-475-2720
Practice Address - Street 1:5311 LIMESTONE RD STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1257
Practice Address - Country:US
Practice Address - Phone:302-234-2200
Practice Address - Fax:302-234-2262
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0008781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE141789ZCCSOtherMEDICARE
DE1134253099Medicaid