Basic Information
| Provider Information | |||||||||
| NPI: | 1518106871 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | BASSEM | ||||||||
| MiddleName: | RAGHEB | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 W ELM ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | CONSHOHOCKEN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194284108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152557822 | ||||||||
| FaxNumber: | 2152557825 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 N BROAD ST | ||||||||
| Address2: | HAHNEMANN UNIVERSITY HOSPITAL/ DREXEL UNIVERSITY | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191021121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157622514 | ||||||||
| FaxNumber: | 2157627701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2009 | ||||||||
| LastUpdateDate: | 11/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 27541 | WV | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | MD445231 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | MD445231 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102700163 | 05 | PA | MEDICAID | MT191253 | 01 | PA | MT LICENSE | OTHER |