Basic Information
| Provider Information | |||||||||
| NPI: | 1912252032 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | GAUTAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 834 WALNUT ST 650 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159555161 | ||||||||
| FaxNumber: | 2159556003 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 MOUNT AUBURN ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021385502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174995160 | ||||||||
| FaxNumber: | 6174995593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2012 | ||||||||
| LastUpdateDate: | 09/04/2019 | ||||||||
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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 | 207R00000X | MD465143 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 251828 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | MD465143 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | MD465143 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.