Provider Demographics
NPI:1700925179
Name:GEORGE, PAZHAYIDATHE K (MD PHD FACP)
Entity Type:Individual
Prefix:
First Name:PAZHAYIDATHE
Middle Name:K
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD PHD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-0247
Mailing Address - Country:US
Mailing Address - Phone:919-269-9111
Mailing Address - Fax:919-269-4747
Practice Address - Street 1:323 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597
Practice Address - Country:US
Practice Address - Phone:919-269-9111
Practice Address - Fax:919-269-4747
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27457207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8935107Medicaid
NC35107OtherBCBS
D45422Medicare UPIN
213680AMedicare ID - Type Unspecified
NC8935107Medicaid