Provider Demographics
NPI:1154736510
Name:BLEWITT, GEORGE AUGUSTINE SR (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:AUGUSTINE
Last Name:BLEWITT
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6902 SAINT ANNES DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17222-9456
Mailing Address - Country:US
Mailing Address - Phone:717-352-2378
Mailing Address - Fax:717-352-2378
Practice Address - Street 1:6902 SAINT ANNES DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17222-9456
Practice Address - Country:US
Practice Address - Phone:717-352-2378
Practice Address - Fax:717-352-2378
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD007052E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine