MEDICARE: SERGEY GEORGIYEVSKY

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
1	207L00000X	Anesthesiology Physician	MD070667L	PA

General Provider Information

NPI Number	:	1235130394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGEY GEORGIYEVSKY

Provider Business Mailing Address
First Line	:	56 N MOUNTAIN BLVD
Second Line	:	JAMESON HOSPITAL
City	:	MOUNTAIN TOP
State	:	PA
Zip	:	18707-1117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 N MOUNTAIN BLVD
Second Line	:	JAMESON HOSPITAL
City	:	MOUNTAIN TOP
State	:	PA
Zip	:	18707-1117
Country	:	US
Telephone Number	:	570-474-1130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/24/2021

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Directions to “ SERGEY GEORGIYEVSKY ” Practice Location

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