1942292461 NPI number — DR. SHARON L GEORGE D.O.

Table of content: DR. SHARON L GEORGE D.O. (NPI 1942292461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942292461 NPI number — DR. SHARON L GEORGE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGE
Provider First Name:
SHARON
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942292461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/25/2006
NPI Reactivation Date:
03/31/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 SOUTHERN BLVD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44485-2537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-898-4300
Provider Business Mailing Address Fax Number:
330-898-5828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 SOUTHERN BLVD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44485-2537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-898-4300
Provider Business Practice Location Address Fax Number:
330-898-5828
Provider Enumeration Date:
08/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  34005112 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000129115 . This is a "UNISON MEDICAID HMO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0849989 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1009042440001 . This is a "MEDICAID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 341819293027 . This is a "CARESOURCE MEDICAID HMO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 34181929310243 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P006767 . This is a "GATEWAY MEDICAID HMO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 010044662 . This is a "RAILROD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3418192932644 . This is a "AETNA PPO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: Q019005 . This is a "THE HEALTH PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000139737 . This is a "ANTHEM INDIVIDUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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