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Individual

MR. GEORGE M PROTENIC

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
826 MAIN ST STE 100, PHOENIXVILLE, PA 19460-4459
(484) 928-6780
(267) 741-0003
Mailing address
207 N BROAD ST FL 3, PHILADELPHIA, PA 19107-1500
(267) 479-4142

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA000658L
PA
363AM0700X
Medical Physician Assistant
MA0006581
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1031466560003
PA
Enumeration date
02/08/2006
Last updated
07/15/2021
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