Provider Demographics
NPI:1184647893
Name:SAKOULAS, GEORGE (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:SAKOULAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 GENESEE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4219
Mailing Address - Country:US
Mailing Address - Phone:858-616-8091
Mailing Address - Fax:858-616-8090
Practice Address - Street 1:2001 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2303
Practice Address - Country:US
Practice Address - Phone:619-446-1727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225011207RI0200X
CAA101504207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00000092881OtherGHI HMO
NY1530027OtherAETNA HMO
NY5699722OtherGHI PPO
NY225011OtherCONNECTICARE
NY317AF1OtherEMPIRE BCBS
NY7480288OtherAETNA PPO
NY391737OtherMVP
NY225011OtherHIP
NYP00290798OtherRAILROAD MEDICARE
NYSG5011OtherATLANTIS
NY02280275Medicaid
NY225011OtherCONNECTICARE