MEDICARE: DR. JEANNINE ERIKA GEORGE D.P.M.

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	174400000X	Specialist	01417	MD
2	213ES0103X	Foot & Ankle Surgery Podiatrist	01417	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528039161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEANNINE ERIKA GEORGE D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 2155
Second Line	:	ELLICOTT CITY
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	:	301-905-2334
Fax Number	:	410-869-4149

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	02/17/2022

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