Basic Information
| Provider Information | |||||||||
| NPI: | 1023245313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 E ADAMS ST - DEPARTMENT OF INTERNAL MEDICINE | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132102342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154645774 | ||||||||
| FaxNumber: | 3154641937 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 E ADAMS ST - DEPARTMENT OF INTERNAL MEDICINE | ||||||||
| Address2: | DEPARTMENT OF INTERNAL MEDICINE | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132102342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154645774 | ||||||||
| FaxNumber: | 3154641937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2009 | ||||||||
| LastUpdateDate: | 02/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 003342 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 003342 | NY | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 285340 | NY | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 285340 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 03136096 | 05 | NY | MEDICAID |