Healthcare Provider Details

I. General information

NPI: 1104816487
Provider Name (Legal Business Name): KEVIN WAYNE GEORGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 KARNER RD UNIT 13385
ALBANY NY
12212-7259
US

IV. Provider business mailing address

110 WOLF RD SUITE 5
COLONIE NY
12205-1244
US

V. Phone/Fax

Practice location:
  • Phone: 518-458-2481
  • Fax: 518-489-4149
Mailing address:
  • Phone: 518-458-2481
  • Fax: 518-489-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number201439
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: