Provider Demographics
NPI:1699921411
Name:GEORGE E. URBAN, JR MD PA
Entity type:Organization
Organization Name:GEORGE E. URBAN, JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:301-868-1234
Mailing Address - Street 1:9131 PISCATAWAY RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2508
Mailing Address - Country:US
Mailing Address - Phone:301-868-1234
Mailing Address - Fax:301-868-2751
Practice Address - Street 1:9131 PISCATAWAY RD
Practice Address - Street 2:SUITE 410
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2508
Practice Address - Country:US
Practice Address - Phone:301-868-1234
Practice Address - Fax:301-868-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB93129Medicare UPIN