Provider Demographics
NPI:1700874104
Name:ABOURJAILY, GEORGES S (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGES
Middle Name:S
Last Name:ABOURJAILY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:887 CONGRESS ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3100
Mailing Address - Country:US
Mailing Address - Phone:207-774-6368
Mailing Address - Fax:207-774-9388
Practice Address - Street 1:887 CONGRESS ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3100
Practice Address - Country:US
Practice Address - Phone:207-774-6368
Practice Address - Fax:207-774-9388
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2008-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME006810208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MED78761Medicare UPIN
MEAX9250Medicare PIN