Provider Demographics
NPI:1902096480
Name:GEORGI, MARC ABOU (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ABOU
Last Name:GEORGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARWAN
Other - Middle Name:SAMIR
Other - Last Name:ABOU GERGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-4001
Practice Address - Fax:703-776-7113
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD449243207R00000X, 207RG0100X
MDD66389207R00000X
SC40127207RG0100X
VA0101274660207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102845106Medicaid
PA2898145OtherHIGHMARK BLUE SHIELD
PA30088992OtherAMERIHEALTH CARITAS PA - WMG
PA420279OtherUPMC
SC401274Medicaid
MDKR65Medicare PIN
PAP01269712 FRDM WAYMedicare PIN
PA102845106Medicaid