Provider Demographics
NPI:1518169713
Name:GEORGE, ASHWIN VINOD (MD)
Entity type:Individual
Prefix:DR
First Name:ASHWIN
Middle Name:VINOD
Last Name:GEORGE
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 1:2428 E 117TH ST
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1269
Mailing Address - Country:US
Mailing Address - Phone:612-444-3000
Mailing Address - Fax:612-444-9000
Practice Address - Street 1:2428 E 117TH ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:612-444-3000
Practice Address - Fax:612-444-9000
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49521207RA0401X, 208VP0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine