Provider Demographics
NPI:1700881653
Name:GEORGE, ENE G (MD)
Entity Type:Individual
Prefix:
First Name:ENE
Middle Name:G
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5162 ST RT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121
Mailing Address - Country:US
Mailing Address - Phone:937-378-3633
Mailing Address - Fax:937-378-6153
Practice Address - Street 1:5162 ST RT
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121
Practice Address - Country:US
Practice Address - Phone:937-378-3633
Practice Address - Fax:937-378-6153
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080161207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2445732Medicaid
OHH99349Medicare UPIN
OH2445732Medicaid