Provider Demographics
NPI:1447550918
Name:GEORGE MOUTSATSOS, MD CARDIOLOGY LLC
Entity type:Organization
Organization Name:GEORGE MOUTSATSOS, MD CARDIOLOGY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DEMETRIOS
Authorized Official - Last Name:MOUTSATSOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-540-2743
Mailing Address - Street 1:904 WESTOVER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2981
Mailing Address - Country:US
Mailing Address - Phone:302-983-6908
Mailing Address - Fax:302-482-3543
Practice Address - Street 1:3521 SILVERSIDE RD
Practice Address - Street 2:QUILLEN BUILDING SUITE 2D1
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4900
Practice Address - Country:US
Practice Address - Phone:302-983-6908
Practice Address - Fax:302-482-3543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006169207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001091101Medicaid
DE0001091101Medicaid