Provost, George L

Provost, George L is an individual health care provider with primary practice located at 1210 Hanover Ave , Allentown PA 18109-2017. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Provost, George L can be contacted via phone (610) 437-6490.

Contact Information

Primary practice address
1210 Hanover Ave Allentown PA 18109-2017
Phone: (610) 437-6490
Fax: (610) 437-4151
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD020842E Pennsylvania

Profile Details

NPI number 1285620641
LBN Legal business name Provost, George L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 21st, 2005
Last updated Sep 10th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285620641 NPPES
Pennsylvania MEDICAID 0017584420001
Pennsylvania Other 014563
Pennsylvania Other P002518
Pennsylvania Other 0040759000
Pennsylvania Other 20011415
Pennsylvania Other 01371901

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