Healthcare Provider Details

I. General information

NPI: 1962534552
Provider Name (Legal Business Name): ST. GEORGE & CO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 S QUEEN ST
YORK PA
17403-4628
US

IV. Provider business mailing address

1776 S QUEEN ST
YORK PA
17403-4628
US

V. Phone/Fax

Practice location:
  • Phone: 717-845-6261
  • Fax: 717-852-0630
Mailing address:
  • Phone: 717-845-6261
  • Fax: 717-852-0630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberOS004419L
License Number StatePA

VIII. Authorized Official

Name: DR. CAROL LINDA ST. GEORGE
Title or Position: PRESIDENT
Credential: D.O.
Phone: 717-845-6261