MEDICARE: DR. GEORGE ZOUGHBI 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	208000000X	Pediatrics Physician	P22861	MD

General Provider Information

NPI Number	:	1962664250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE ZOUGHBI M.D.

Provider Business Mailing Address
First Line	:	4935 LANIER AVE APT A
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-5354
Country	:	US
Telephone Number	:	315-378-7193
Fax Number	:

Provider Business Practice Location Address
First Line	:	4935 LANIER AVE APT A
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-5354
Country	:	US
Telephone Number	:	315-378-7193
Fax Number	:

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

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	06/27/2008

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