Provider Demographics
NPI:1144491317
Name:GEORGE C TSOUTSOPLIDES MD
Entity type:Organization
Organization Name:GEORGE C TSOUTSOPLIDES MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TSOUTSOPLIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-287-5900
Mailing Address - Street 1:534 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3742
Mailing Address - Country:US
Mailing Address - Phone:570-287-5900
Mailing Address - Fax:570-287-6610
Practice Address - Street 1:534 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3742
Practice Address - Country:US
Practice Address - Phone:570-287-5900
Practice Address - Fax:570-287-6610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
16152OtherGEISINGER
PA0006115260001Medicaid
74434OtherUNISON
507319OtherAETNA
072228OtherFIRST PRIORITY
TS138502OtherBCBS
74434OtherUNISON