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1780680009

NPI Code Detail

MEDICARE: MARINA GEORGE MD

MEDICARE: MARINA GEORGE 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
1	207R00000X	Internal Medicine Physician	N0040	TX
2	207RH0003X	Hematology & Oncology Physician	002150	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00888454	OTHER	TX	RR MEDICARE (MDACC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8U3437	OTHER	TX	BCBS (MDACC)

General Provider Information

NPI Number	:	1780680009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA GEORGE MD

Provider Business Mailing Address
First Line	:	PO BOX 4439
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77210-4439
Country	:	US
Telephone Number	:	713-792-2991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 HOLCOMBE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4009
Country	:	US
Telephone Number	:	713-792-6161
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/19/2012

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Directions to “ MARINA GEORGE MD” Practice Location

Language	Start Address	Practice Location

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