Provider Demographics
NPI:1205090917
Name:KOBERLEIN, GEORGE C (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:C
Last Name:KOBERLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 5031
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4251
Mailing Address - Fax:513-636-8145
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 5031
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-4251
Practice Address - Fax:513-636-8145
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010929342085R0202X
NC2014-005702085R0202X
OH35.1209062085R0202X, 2085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5114457OtherUNITED HEALTHCARE
NC1205090917Medicaid
SCQ70014OtherSC MEDICAID
NC1205090917OtherTRICARE
NC1868WOtherBCBS
NC4105367OtherAETNA
VA1205090917OtherVIRGINIA MEDICAID
NC281983OtherMEDCOST
SCQ70014OtherSC MEDICAID