Provider Demographics
NPI:1316924673
Name:VOGELGESANG, GEORGE W (DO)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:VOGELGESANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-8624
Mailing Address - Country:US
Mailing Address - Phone:330-837-3559
Mailing Address - Fax:330-837-3052
Practice Address - Street 1:3545 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8624
Practice Address - Country:US
Practice Address - Phone:330-837-3559
Practice Address - Fax:330-837-3052
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-1983-V174400000X
OH34-001983207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0201409Medicaid
OH0201409Medicaid
OHA74185Medicare UPIN