MEDICARE: DR. ELIZEBATH GEORGE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35-079018	OH

General Provider Information

NPI Number	:	1205856697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZEBATH GEORGE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 74224
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44194-0002
Country	:	US
Telephone Number	:	216-383-6480
Fax Number	:	216-383-6745

Provider Business Practice Location Address
First Line	:	3909 ORANGE PL
Second Line	:	#2100
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4478
Country	:	US
Telephone Number	:	216-896-1800
Fax Number	:	216-896-1801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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