Provider Demographics
NPI:1306925912
Name:GEORGE, ARTHUR RICHARD (RPAC)
Entity type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:RICHARD
Last Name:GEORGE
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-272-7000
Mailing Address - Fax:607-272-4604
Practice Address - Street 1:1301 TRUMANSBURG RD
Practice Address - Street 2:SUITE R
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1397
Practice Address - Country:US
Practice Address - Phone:607-272-7000
Practice Address - Fax:607-272-4604
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0010861363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01281236Medicaid
NY01281236Medicaid