Provider Demographics
NPI:1912147273
Name:WIDHSON, GEORGE E III (HIS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:E
Last Name:WIDHSON
Suffix:III
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:611 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCKLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19046-4456
Mailing Address - Country:US
Mailing Address - Phone:215-379-2256
Mailing Address - Fax:215-379-2331
Practice Address - Street 1:611 HUNTINGDON PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4456
Practice Address - Country:US
Practice Address - Phone:215-379-2256
Practice Address - Fax:215-379-2331
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0250500237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0250500OtherHEARING AID FITTER PA DEPTARTMENT OF HEALTH NUMBER