Provider Demographics
NPI:1144300484
Name:VAILAS, GEORGE NIKITA (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:NIKITA
Last Name:VAILAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 MISTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8204
Mailing Address - Country:US
Mailing Address - Phone:713-436-6417
Mailing Address - Fax:713-436-6418
Practice Address - Street 1:2006 MISTWOOD CT
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8204
Practice Address - Country:US
Practice Address - Phone:713-436-6417
Practice Address - Fax:713-436-6418
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK52332080N0001X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8A8009Medicare ID - Type Unspecified
E49112Medicare UPIN