Healthcare Provider Details

I. General information

NPI: 1265593578
Provider Name (Legal Business Name): GEORGE LARRY MAXWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WRAMC DEPARTMENT 6900 GEORGIA AVE. NW
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

2 WRAMC ROOM 2J38 6900 GEORGIA AVE. NW
WASHINGTON DC
20307-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-6201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number9600093
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: