Provider Demographics
NPI:1104816487
Name:GEORGE, KEVIN WAYNE (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:WAYNE
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:110 WOLF RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:COLONIE
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1244
Mailing Address - Country:US
Mailing Address - Phone:518-458-2481
Mailing Address - Fax:518-489-4149
Practice Address - Street 1:30 KARNER RD
Practice Address - Street 2:UNIT 13385
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12212-7259
Practice Address - Country:US
Practice Address - Phone:518-458-2481
Practice Address - Fax:518-489-4149
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2017-02-16
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Provider Licenses
StateLicense IDTaxonomies
NY2014392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA1557Medicare PIN
NYG76059Medicare UPIN