Basic Information
| Provider Information | |||||||||
| NPI: | 1609150937 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ST GEORGE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1340 BOYLSTON ST | ||||||||
| Address2: | ANSIN BUILDING | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022154302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172670900 | ||||||||
| FaxNumber: | 6172473912 | ||||||||
| Practice Location | |||||||||
| Address1: | 1340 BOYLSTON ST | ||||||||
| Address2: | ANSIN BUILDING | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022154302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172670900 | ||||||||
| FaxNumber: | 6172473912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2011 | ||||||||
| LastUpdateDate: | 09/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA4273 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.