Healthcare Provider Details

I. General information

NPI: 1861406977
Provider Name (Legal Business Name): MARIE J GEORGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR
BENNINGTON VT
05201-5004
US

IV. Provider business mailing address

100 HOSPITAL DR
BENNINGTON VT
05201-5004
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-5544
  • Fax: 802-447-5589
Mailing address:
  • Phone: 802-447-5544
  • Fax: 802-447-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberT1024
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number042-0009889
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: