Healthcare Provider Details

I. General information

NPI: 1497744940
Provider Name (Legal Business Name): GEORGE T VEINOGLOU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 MAIN ST
GREAT BARRINGTON MA
01230-1822
US

IV. Provider business mailing address

777 NORTH ST PO BOX 1677
PITTSFIELD MA
01202-1677
US

V. Phone/Fax

Practice location:
  • Phone: 413-644-6499
  • Fax: 413-644-6497
Mailing address:
  • Phone: 413-445-6420
  • Fax: 413-499-4907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number56720
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: