Provider Demographics
NPI:1699085175
Name:GEORGE PAPANICOLAOU, MD PA
Entity type:Organization
Organization Name:GEORGE PAPANICOLAOU, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPANICOLAOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-478-3151
Mailing Address - Street 1:3272 W LAKE MARY BLVD STE 1810
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3589
Mailing Address - Country:US
Mailing Address - Phone:407-478-3151
Mailing Address - Fax:407-339-4267
Practice Address - Street 1:3272 W LAKE MARY BLVD STE 1810
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3589
Practice Address - Country:US
Practice Address - Phone:407-478-3151
Practice Address - Fax:407-339-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85966208200000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001633300Medicaid