Basic Information
| Provider Information | |||||||||
| NPI: | 1609076165 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PFEIFFER | ||||||||
| FirstName: | MARYELLEN | ||||||||
| MiddleName: | ESTEVEZ | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ESTEVEZ | ||||||||
| OtherFirstName: | MARYELLEN | ||||||||
| OtherMiddleName: | E | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1001 S GEORGE ST | ||||||||
| Address2: | FL 4 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516969 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 S GEORGE ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178514005 | ||||||||
| FaxNumber: | 7178122495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | OS013949 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | OS013949 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1582461 | 01 | PA | GATEWAY-WMG | OTHER | 033831100 | 05 | MD | MEDICAID | 2109718 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 30131964 | 01 | PA | AMERIHEALTH MERCY - WMG | OTHER | 953500 | 01 | MD | CAREFIRST MD BCBS-WMG | OTHER | 20091168 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 272755 | 01 | PA | UNISON-WMG | OTHER | 102179302 | 05 | PA | MEDICAID |