Individual
DR. GEORGE T FANTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-8732
(410) 328-8315
Mailing address
PO BOX 64442, BALTIMORE, MD 21264-4442
(410) 328-8732
(410) 328-8315
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
D40061
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
069451700
—
MD
05
—
1043272610
—
DE
01
—
520626-02 & 01
BLUE CROSS/BLUE SHIELD
MD
Enumeration date
04/06/2006
Last updated
11/12/2010
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