MEDICARE: JEANNINE E. GEORGE DPM PC.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	01417	MD

General Provider Information

NPI Number	:	1487898409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEANNINE E. GEORGE DPM PC.

Provider Business Mailing Address
First Line	:	PO BOX 2155
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21041-2155
Country	:	US
Telephone Number	:	410-869-4147
Fax Number	:	410-869-4149

Provider Business Practice Location Address
First Line	:	3450 ELLICOTT CENTER DR STE 105
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4666
Country	:	US
Telephone Number	:	410-203-2807
Fax Number	:	410-203-2809

Authorized Official
Title or Position	:	PODIATRIST/OWNER
Name	:	DR. JEANNINE ERIKA GEORGE
Credential	:	D.P.M.
Telephone Number	:	410-203-2807

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	11/13/2020

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