Provider Demographics
NPI:1124080122
Name:GEORGE, LINDA JOAN (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JOAN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2364 UPPER GREENS PL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3587
Mailing Address - Country:US
Mailing Address - Phone:757-563-9291
Mailing Address - Fax:757-962-1185
Practice Address - Street 1:1856 COLONIAL MEDICAL CT
Practice Address - Street 2:SUITE A
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3075
Practice Address - Country:US
Practice Address - Phone:757-962-6262
Practice Address - Fax:757-962-1185
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F57011Medicare UPIN