Provider Demographics
NPI:1699753244
Name:GEORGE, MAUREEN L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:L
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1730
Mailing Address - Country:US
Mailing Address - Phone:724-567-4441
Mailing Address - Fax:724-547-4311
Practice Address - Street 1:828 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1730
Practice Address - Country:US
Practice Address - Phone:724-547-4441
Practice Address - Fax:724-547-4311
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052385363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA052385OtherMEDICAL LICENSE
1067695OtherNCCPA CERTIFICATE NUMBER