MEDICARE: KATELYN MARIE GEORGE

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1912569997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN MARIE GEORGE

Provider Business Mailing Address
First Line	:	40 SHADY NOOK AVE
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-3535
Country	:	US
Telephone Number	:	610-603-6568
Fax Number	:

Provider Business Practice Location Address
First Line	:	8028 RITCHIE HWY STE 120
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-1069
Country	:	US
Telephone Number	:	410-590-8750
Fax Number	:

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

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	07/01/2019

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