Healthcare Provider Details

I. General information

NPI: 1194042747
Provider Name (Legal Business Name): KIRSTEN CAROL GEORGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2010
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 STATE ST STE 328
ERIE PA
16501-1419
US

IV. Provider business mailing address

2501 W 12TH ST # 155
ERIE PA
16505-4527
US

V. Phone/Fax

Practice location:
  • Phone: 814-325-9409
  • Fax: 814-325-9805
Mailing address:
  • Phone: 814-325-9409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD447246
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0079465
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: