Provider Demographics
NPI:1700875010
Name:CAIN, GEORGE PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:PATRICK
Last Name:CAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 W 12TH AVE
Mailing Address - Street 2:RM 460
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1267
Mailing Address - Country:US
Mailing Address - Phone:614-293-8299
Mailing Address - Fax:614-293-6935
Practice Address - Street 1:395 W 12TH AVE
Practice Address - Street 2:RM 460
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-293-8299
Practice Address - Fax:614-293-6935
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350372602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0336818Medicaid
F16974Medicare UPIN
OH0336818Medicaid