Provider Demographics
NPI:1033143367
Name:SKINNER, ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:SKINNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1301
Mailing Address - Country:US
Mailing Address - Phone:607-547-3480
Mailing Address - Fax:607-547-5034
Practice Address - Street 1:2031 DREAM CATCHER PLZ
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2729
Practice Address - Country:US
Practice Address - Phone:315-231-5400
Practice Address - Fax:315-363-3540
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009192L207Q00000X
NY288899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102823OtherJOHNS HOPKINS
PA176515OtherUNISON-WMG
PA30113686OtherAMERIHEALTH MERCY - WMG
PA2143925OtherMAMSI-WMG
PAP006960OtherGATEWAY-WMG
PA101479135Medicaid
PA50056184OtherCAPITAL BLUE CROSS-WMG
MD648850OtherCAREFIRST MD BCBS
PA20049247OtherAMERIHEALTH MERCY-WMG
PA7107910OtherAETNA
PA100486OtherGEISINGER
PA1804786OtherHIGHMARK BLUE SHIELD
MD648850OtherCAREFIRST MD BCBS
PA176515OtherUNISON-WMG
PA102823OtherJOHNS HOPKINS