Provider Demographics
NPI:1740289008
Name:ZAVITSANOS, GEORGE PETER (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:PETER
Last Name:ZAVITSANOS
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 1:467 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3420
Mailing Address - Country:US
Mailing Address - Phone:215-641-2300
Mailing Address - Fax:215-628-2411
Practice Address - Street 1:467 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3420
Practice Address - Country:US
Practice Address - Phone:215-641-2300
Practice Address - Fax:215-628-2411
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042591L2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017043800002Medicaid
PA887827Medicare ID - Type Unspecified
PA0017043800002Medicaid