Basic Information
| Provider Information | |||||||||
| NPI: | 1215931654 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RUEDISUELI | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174218 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 KEEFER DRIVE | ||||||||
| Address2: | MERCERSBURG HEALTH CENTER | ||||||||
| City: | MERCERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172361732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173282115 | ||||||||
| FaxNumber: | 7173284322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 01/07/2010 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD023513E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080058982 | 01 | PA | RAILROAD MEDICARE | OTHER | 50014147 | 01 | PA | CAPITAL BLUECROSS | OTHER | AG9303708 | 01 | PA | DEA | OTHER | 120420401 | 01 | PA | DEPT OF LABOR | OTHER | 427341 | 01 | PA | HEALTH AMERICA | OTHER | 4314403 | 01 | PA | AETNA NON-HMO | OTHER | 841849 | 01 | PA | AETNA HMO | OTHER | 000660530 0007 | 05 | PA | MEDICAID | MD023513E | 01 | PA | LICENSE | OTHER | 2106632 | 01 | PA | MAMSI | OTHER | 25-1716306 | 01 | PA | GREATWEST | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | P003060 | 01 | PA | GATEWAY | OTHER | 144631 | 01 | PA | UNISON | OTHER | 25-1716306 | 01 | PA | INFORMED | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 159862 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 2160154 | 01 | PA | FIRST HEALTH | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER |