Provider Demographics
NPI:1992870885
Name:MCCORD, GEORGE ELLIOTT (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:ELLIOTT
Last Name:MCCORD
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 1:6418 LANDBOROUGH SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4357
Mailing Address - Country:US
Mailing Address - Phone:317-845-1305
Mailing Address - Fax:317-842-3621
Practice Address - Street 1:7301 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2085
Practice Address - Country:US
Practice Address - Phone:317-845-1305
Practice Address - Fax:317-842-3641
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021201174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000090298OtherANTHEM BLUE NETWORK
IN351924614002OtherANTHEM BCBS
P00140039Medicare PIN
IN351924614002OtherANTHEM BCBS
1174910001Medicare NSC
248220AMedicare PIN