Provider Demographics
NPI:1881797454
Name:GLEESON, GEORGE HENRY (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:HENRY
Last Name:GLEESON
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 1:532 SOUTH AIKEN AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232
Mailing Address - Country:US
Mailing Address - Phone:412-621-5091
Mailing Address - Fax:412-621-5107
Practice Address - Street 1:532 SOUTH AIKEN AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232
Practice Address - Country:US
Practice Address - Phone:412-621-5091
Practice Address - Fax:412-621-5107
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018263E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA251185OtherVPMC HEALTH PLAN
PA0006069830010Medicaid
PA000031922OtherHIGHMARK BCBS
C28051Medicare UPIN
PA0006069830010Medicaid