Provider Demographics
NPI:1336146521
Name:VANWEELDEN, GEORGE (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:VANWEELDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 SUMMIT AVE
Mailing Address - Street 2:MSO PHYSICIAN BILLING
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2667
Mailing Address - Country:US
Mailing Address - Phone:740-283-7776
Mailing Address - Fax:740-283-7190
Practice Address - Street 1:864 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3870
Practice Address - Country:US
Practice Address - Phone:740-266-3855
Practice Address - Fax:740-266-3860
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.006287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00060764OtherRR MEDICARE
OH2016553Medicaid
WV0047564000Medicaid
OH0820586Medicare PIN
WV0047564000Medicaid
OHP00060764OtherRR MEDICARE
OH0820585Medicare PIN
OH9285544Medicare PIN
OH0820584Medicare PIN