Basic Information
| Provider Information | |||||||||
| NPI: | 1326016866 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNAPPENBERGER | ||||||||
| FirstName: | GEORGE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1350 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444836608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308419822 | ||||||||
| FaxNumber: | 3308419281 | ||||||||
| Practice Location | |||||||||
| Address1: | 1350 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444836608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308419822 | ||||||||
| FaxNumber: | 3308419281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 35078786 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2380392 | 05 | OH | MEDICAID |