Provider Demographics
NPI:1962570473
Name:TREMITI, GEORGE O (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:O
Last Name:TREMITI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066
Mailing Address - Country:US
Mailing Address - Phone:315-329-7770
Mailing Address - Fax:
Practice Address - Street 1:4206 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 206
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6642
Practice Address - Country:US
Practice Address - Phone:315-329-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153041-1208600000X
NY1530419207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00895372Medicaid
NY53991BMedicare UPIN