Healthcare Provider Details

I. General information

NPI: 1922034412
Provider Name (Legal Business Name): GEORGE C. TSOUTSOPLIDES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 WYOMING AVENUE
KINGSTON PA
18704
US

IV. Provider business mailing address

534 WYOMING AVENUE
KINGSTON PA
18704
US

V. Phone/Fax

Practice location:
  • Phone: 570-287-5900
  • Fax: 570-287-6610
Mailing address:
  • Phone: 570-287-5900
  • Fax: 570-287-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD033584L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: