Provider Demographics
NPI:1487898409
Name:JEANNINE E. GEORGE DPM PC.
Entity type:Organization
Organization Name:JEANNINE E. GEORGE DPM PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:ERIKA
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-203-2807
Mailing Address - Street 1:PO BOX 2155
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21041-2155
Mailing Address - Country:US
Mailing Address - Phone:410-869-4147
Mailing Address - Fax:410-869-4149
Practice Address - Street 1:3450 ELLICOTT CENTER DR STE 105
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4666
Practice Address - Country:US
Practice Address - Phone:410-203-2807
Practice Address - Fax:410-203-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01417213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5555040001Medicare NSC
MD234066Medicare PIN
DC234533Medicare PIN