Provider Demographics
NPI:1912909235
Name:KEFALAS, GEORGE H (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:H
Last Name:KEFALAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2600 TUSCARAWAS ST W
Mailing Address - Street 2:STE 100
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4696
Mailing Address - Country:US
Mailing Address - Phone:330-452-8844
Mailing Address - Fax:330-452-7012
Practice Address - Street 1:2600 TUSCARAWAS ST W
Practice Address - Street 2:STE 100
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4696
Practice Address - Country:US
Practice Address - Phone:330-452-8844
Practice Address - Fax:330-452-7012
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-081058207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000186367OtherUNISON HEALTH PLAN
341574729038OtherCARESOURCE
OH2560607Medicaid
OH000000364351OtherANTHEM BC/BS
341574729NOtherAULTCARE
Q041672OtherTHE HEALTH PLAN
733472OtherBUCKEYE COMMUNITY HEALTH
Q041672OtherTHE HEALTH PLAN
000000186367OtherUNISON HEALTH PLAN
P00234767Medicare PIN