Individual
GEORGE A SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 IRVING ST NW, RM 4B42, WASHINGTON, DC 20010-2976
(202) 877-7259
(202) 877-7258
Mailing address
1201 SEVEN LOCKS RD, SUITE 200, ROCKVILLE, MD 20854-2931
(301) 652-5771
(301) 652-6332
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD17192
DC
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
MD17192
DC
207RP1001X
Pulmonary Disease Physician
MD17192
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026108100
—
DC
05
—
282871700
—
MD
05
—
6002331
—
VA
Enumeration date
10/19/2006
Last updated
02/14/2012
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