Basic Information
| Provider Information | |||||||||
| NPI: | 1609850759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 SUMMER ST | ||||||||
| Address2: | STE 7350 | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016081216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083636849 | ||||||||
| FaxNumber: | 5083637461 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 SUMMER ST | ||||||||
| Address2: | STE 7350 | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016081216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083636849 | ||||||||
| FaxNumber: | 5083637461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 08/13/2015 | ||||||||
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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 | 209762 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0402311 | 01 | EVERCARE | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 042472266 | 01 | TRICARE CHAMPUS | OTHER | 1973721 | 01 | FIRST HEALTH | OTHER | 3643856 | 01 | AETNA US HEALTHCARE | OTHER | J23362 | 01 | BLUE SHIELD INDEMNITY | OTHER | 9358242 | 01 | CIGNA HEALTH PLAN | OTHER | 110221674 | 01 | RAILROAD MEDICARE | OTHER | 042472266 | 01 | UNITED HEALTHCARE | OTHER | 110002708A | 05 | MA | MEDICAID | 784020 | 01 | MVP HEALTH CARE | OTHER | J23362 | 01 | BLUE CARE ELECT | OTHER | 0132373 | 01 | HEALTHY START | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | AA2220 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | 61236 | 01 | FALLON COMMUNITY HEALTH | OTHER | J23362 | 01 | BLUE SHIELD HMO BLUE | OTHER | 042472266 | 01 | HEALTHCARE VALUE | OTHER | 441341 | 01 | TUFTS HEALTH PLAN | OTHER |