Provider Demographics
NPI:1992721708
Name:CHEPONIS, GEORGE B (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:B
Last Name:CHEPONIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1155 MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:AMBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15003-2375
Mailing Address - Country:US
Mailing Address - Phone:724-266-0707
Mailing Address - Fax:724-266-3978
Practice Address - Street 1:1155 MERCHANT ST
Practice Address - Street 2:
Practice Address - City:AMBRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15003-2375
Practice Address - Country:US
Practice Address - Phone:724-266-0707
Practice Address - Fax:724-266-3978
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015931E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009926470001Medicaid
PA076616LCKMedicare PIN
B35093Medicare UPIN