Healthcare Provider Details

I. General information

NPI: 1699085175
Provider Name (Legal Business Name): GEORGE PAPANICOLAOU, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3272 W LAKE MARY BLVD STE 1810
LAKE MARY FL
32746-3589
US

IV. Provider business mailing address

3272 W LAKE MARY BLVD STE 1810
LAKE MARY FL
32746-3589
US

V. Phone/Fax

Practice location:
  • Phone: 407-478-3151
  • Fax: 407-339-4267
Mailing address:
  • Phone: 407-478-3151
  • Fax: 407-339-4267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberME85966
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME85966
License Number StateFL

VIII. Authorized Official

Name: DR. GEORGE PAPANICOLAOU
Title or Position: PRESIDENT
Credential: MD
Phone: 407-478-3151