Basic Information
| Provider Information | |||||||||
| NPI: | 1033119755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | B. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174218 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 KEEFER DR | ||||||||
| Address2: | |||||||||
| City: | MERCERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172361732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173282119 | ||||||||
| FaxNumber: | 7173280071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 03/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD023514E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 120420401 | 01 | PA | DEPT OF LABOR | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | 647192-01 | 01 | PA | CAREFIRST MD | OTHER | 122751 | 01 | PA | UNISON | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | AG9303695 | 01 | PA | DEA | OTHER | MD023514E | 01 | PA | LICENSE | OTHER | 0006605850005 | 05 | PA | MEDICAID | 080080371 | 01 | PA | RAILROAD MEDICARE | OTHER | 1007307260034 | 01 | PA | MEDICAID GROUP # | OTHER | 1336352 | 01 | PA | FIRST HEALTH | OTHER | 25-1716306 | 01 | PA | INFORMED | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | 427996 | 01 | PA | HEALTH AMERICA | OTHER | P005041 | 01 | PA | GATEWAY | OTHER | U804-0002 | 01 | PA | CAREFIRST DC | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 4278205 | 01 | PA | AETNA NON-HMO | OTHER | 237314 | 01 | PA | MAMSI | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | GE160950 | 01 | PA | HIGHMARK BLUESHIELD | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 50001114 | 01 | PA | CAPITAL BLUECROSS | OTHER | 942120 | 01 | PA | AETNA HMO | OTHER |