Provider Demographics
NPI:1760650386
Name:VAIL, GEORGE MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MATTHEW
Last Name:VAIL
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 1:1100 REID PARKWAY
Mailing Address - Street 2:MEDICAL STAFF SERIVCES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8802
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:1050 REID PKWY STE 205
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1159
Practice Address - Country:US
Practice Address - Phone:765-935-8928
Practice Address - Fax:765-935-8929
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044013A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01170536OtherRR MEDICARE PTAN
IN200104510Medicaid
INM400052497Medicare PIN
IN200104510Medicaid
IN25130007Medicare PIN