Provider Demographics
NPI:1548341464
Name:DIXON, GEORGE CARLTON (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:CARLTON
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:222 BERGEN BLVD
Mailing Address - Street 2:STE 8
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022
Mailing Address - Country:US
Mailing Address - Phone:201-945-1156
Mailing Address - Fax:201-945-0012
Practice Address - Street 1:210 MEADOWLANDS AVE
Practice Address - Street 2:CARE STATION 4
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094
Practice Address - Country:US
Practice Address - Phone:201-348-3636
Practice Address - Fax:201-583-0713
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA53094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P1281905OtherOXFORD
57Y501OtherWELL CHOICE
1K9047OtherHEALTHNET
543866OtherONE HEALTH PLAN
57Y501OtherWELL CHOICE
448145RB9Medicare PIN