Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD444190 | PA |
N | 111NI0900X | Internist | MD444190 | PA |
Y | 207RR0500X | Rheumatology | MD444190 | PA |
NPI | 1104002039 |
---|---|
Provider Name | Michael D George |
First Address | Philadelphia, PA 19104-5502 |
Second Address | Philadelphia, PA 19104-5502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2008 |
Last Update Date | 08/04/2019 |