Provider Demographics
NPI:1023245313
Name:GEORGE, TANYA M (MD)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:M
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E ADAMS ST - DEPARTMENT OF INTERNAL MEDICINE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2342
Mailing Address - Country:US
Mailing Address - Phone:315-464-5774
Mailing Address - Fax:315-464-1937
Practice Address - Street 1:750 E ADAMS ST - DEPARTMENT OF INTERNAL MEDICINE
Practice Address - Street 2:DEPARTMENT OF INTERNAL MEDICINE
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2342
Practice Address - Country:US
Practice Address - Phone:315-464-5774
Practice Address - Fax:315-464-1937
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003342207R00000X, 208M00000X
NY285340208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03136096Medicaid
NYJ400006104Medicare PIN