Provider Demographics
NPI:1699904821
Name:QING GE, M.D.
Entity type:Organization
Organization Name:QING GE, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:QING
Authorized Official - Middle Name:
Authorized Official - Last Name:GE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:386-788-6198
Mailing Address - Street 1:1515 HERBERT ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-6104
Mailing Address - Country:US
Mailing Address - Phone:386-788-6198
Mailing Address - Fax:386-788-4616
Practice Address - Street 1:1515 HERBERT ST
Practice Address - Street 2:SUITE 208
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6104
Practice Address - Country:US
Practice Address - Phone:386-788-6198
Practice Address - Fax:386-788-4616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 96155332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277580800Medicaid
FLI71676Medicare UPIN
FL277580800Medicaid
FLAC234Medicare PIN