Basic Information
| Provider Information | |||||||||
| NPI: | 1982921045 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DEGEORGE | ||||||||
| FirstName: | VINCENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 526 | ||||||||
| Address2: | GEAUGA ANESTHESIA INC. | ||||||||
| City: | NOVELTY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440720526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402876025 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13207 RAVENNA RD | ||||||||
| Address2: | UNIVERSITY HOSPITALS GEAUGA MEDICAL CENTER | ||||||||
| City: | CHARDON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440247032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402856000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2010 | ||||||||
| LastUpdateDate: | 05/16/2014 | ||||||||
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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 | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 35.123138 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.