Provider Demographics
NPI:1093762270
Name:ENCARNACION, ELMYRA V (MD)
Entity Type:Individual
Prefix:
First Name:ELMYRA
Middle Name:V
Last Name:ENCARNACION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1000 E MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0027
Practice Address - Country:US
Practice Address - Phone:570-808-6026
Practice Address - Fax:570-808-3208
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN50372084N0400X
PAMD4220422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1882268-01Medicaid
TX8W9869OtherBLUE CROSS BLUE SHIELD
TXP00455664OtherRAILROAD MEDICARE
TX1882268-01Medicaid
TXP00455664OtherRAILROAD MEDICARE