Healthcare Provider Details

I. General information

NPI: 1982921045
Provider Name (Legal Business Name): VINCENT DEGEORGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13207 RAVENNA RD UNIVERSITY HOSPITALS GEAUGA MEDICAL CENTER
CHARDON OH
44024-7032
US

IV. Provider business mailing address

PO BOX 526 GEAUGA ANESTHESIA INC.
NOVELTY OH
44072-0526
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-6000
  • Fax:
Mailing address:
  • Phone: 440-287-6025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.123138
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: