Provider Demographics
NPI:1285732826
Name:SACHARIAH, K. GEORGE (MD)
Entity type:Individual
Prefix:
First Name:K. GEORGE
Middle Name:
Last Name:SACHARIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 MILL ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6138
Mailing Address - Country:US
Mailing Address - Phone:301-733-1031
Mailing Address - Fax:301-733-3041
Practice Address - Street 1:901 OAK PARK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3408
Practice Address - Country:US
Practice Address - Phone:805-489-2205
Practice Address - Fax:805-489-2206
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020247207R00000X, 207UN0901X
CAA41129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD258831500Medicaid
MD258831500Medicaid
MD170L070BMedicare ID - Type Unspecified