Provider Demographics
NPI:1700823820
Name:GARCIA, GEORGE A (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:GARCIA
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 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-5172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74547207L00000X
RIMD15558207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3208371Medicaid
MA34375OtherBOSTON MEDICAL CENTER
MA074547OtherTUFTS HEALTH PLAN
MA3106471OtherHEALTHY START
MA45209OtherFALLON
MA0007865OtherNEIGHBORHOOD HEALTH
MAJ17776OtherBLUE SHIELD
MA050083210OtherTRAVELER'S MEDICARE
MA275139OtherHARVARD PILGRIM
MA45209OtherFALLON
MAA2245401Medicare PIN
MAA22454Medicare PIN