Provider Demographics
NPI:1801802624
Name:WIDHSON, GEORGE E (HAF)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:E
Last Name:WIDHSON
Suffix:
Gender:M
Credentials:HAF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6224 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2631
Mailing Address - Country:US
Mailing Address - Phone:215-487-1050
Mailing Address - Fax:
Practice Address - Street 1:6224 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19128-2631
Practice Address - Country:US
Practice Address - Phone:215-487-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2077237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist