Healthcare Provider Details

I. General information

NPI: 1821099011
Provider Name (Legal Business Name): GEORGE A SMALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 E NORTH AVE STE 500
PITTSBURGH PA
15212-4765
US

IV. Provider business mailing address

490 E NORTH AVE STE 500
PITTSBURGH PA
15212-4765
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-8860
  • Fax: 412-359-8809
Mailing address:
  • Phone: 412-359-8860
  • Fax: 412-359-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD049217L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD049217L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: