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NPI Code Detail

MEDICARE: GEORGE CHUDOLIJ MD

MEDICARE: GEORGE CHUDOLIJ MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician47714MA
2207LP2900XPain Medicine (Anesthesiology) Physician47714MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003817560
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGE CHUDOLIJ MD
Provider Business Mailing Address
First Line : PO BOX 3008
Second Line :
City : LEWISTON
State : ME
Zip : 04243-3008
Country : US
Telephone Number : 800-720-1664
Fax Number : 207-753-2020
Provider Business Practice Location Address
First Line : 326 NICHOLS RD
Second Line : SUITE 16
City : FITCHBURG
State : MA
Zip : 01420-1914
Country : US
Telephone Number : 978-665-5800
Fax Number : 978-665-5802
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 12/11/2007

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