Healthcare Provider Details

I. General information

NPI: 1285732826
Provider Name (Legal Business Name): K. GEORGE SACHARIAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 OAK PARK BLVD SUITE 101
PISMO BEACH CA
93449-3408
US

IV. Provider business mailing address

336 MILL ST
HAGERSTOWN MD
21740-6138
US

V. Phone/Fax

Practice location:
  • Phone: 805-489-2205
  • Fax: 805-489-2206
Mailing address:
  • Phone: 301-733-1031
  • Fax: 301-733-3041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0020247
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberD0020247
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA41129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: