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NPI Code Detail

MEDICARE: NYASHA KIANNE GEORGE MD

MEDICARE: NYASHA KIANNE 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
1207Q00000XFamily Medicine PhysicianMD455955PA

General Provider Information

NPI Number : 1801138334
Entity Type Code : Individual
Provider Name (Legal Business Name) : NYASHA KIANNE GEORGE MD
Provider Business Mailing Address
First Line : 2144 CECIL B MOORE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19121-4014
Country : US
Telephone Number : 215-320-6187
Fax Number :
Provider Business Practice Location Address
First Line : 2144 CECIL B MOORE AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19121-4014
Country : US
Telephone Number : 215-320-6187
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2013
Last Update Date : 07/28/2020

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