Basic Information
Provider Information | |||||||||
NPI: | 1386697001 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CODORI | ||||||||
FirstName: | GREGORY | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1803 MOUNT ROSE AVE | ||||||||
Address2: | SUITE B3 | ||||||||
City: | YORK | ||||||||
State: | PA | ||||||||
PostalCode: | 174033026 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7178511405 | ||||||||
FaxNumber: | 7173374249 | ||||||||
Practice Location | |||||||||
Address1: | 147 GETTYS ST | ||||||||
Address2: |   | ||||||||
City: | GETTYSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 173252534 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7173374216 | ||||||||
FaxNumber: | 7173374249 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/17/2006 | ||||||||
LastUpdateDate: | 06/10/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OS008086L | PA | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 1521174 | 01 | PA | GATEWAY | OTHER | 412782 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 413903 | 01 | PA | UPMC | OTHER | 001483743 | 05 | PA |   | MEDICAID | 144650 | 01 | PA | UNITED HEALTHCARE COMM PLAN | OTHER | 20016168 | 01 | PA | AMERIHEALTH MERCY | OTHER | 50067124 | 01 | PA | CAPITAL BLUE CROSS | OTHER |