Provider Demographics
NPI:1699766584
Name:ODELL, GEORGE J (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:ODELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2002 MEDICAL PKWY
Mailing Address - Street 2:SUITE #235
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-266-2770
Mailing Address - Fax:410-841-6251
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE #235
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-266-2770
Practice Address - Fax:410-841-6251
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00472902085R0204X
CAG745692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2622593OtherAETNA HMO/POS
MD10690005OtherBCBS
MDA17OtherAAD PG COUNTY
MD300051935OtherTRAVELERS RR MEDICARE
MD732COtherAAD SHIPLEYS
MD462150600Medicaid
MD27ANOtherAAD AA COUNTY
MD300094986OtherSHIPLEYS - RR MEDICARE
MD8317071OtherAETNA PPO
MD300135429Medicare PIN
MD300051935Medicare PIN
MD300051935OtherTRAVELERS RR MEDICARE
MD732COtherAAD SHIPLEYS
MD300094986OtherSHIPLEYS - RR MEDICARE