Provider Demographics
NPI:1205867405
Name:D'EMILIO, MARY THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:THERESA
Last Name:D'EMILIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:T
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-2479
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-2672
Practice Address - Fax:717-851-2479
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022813E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001024858Medicaid
PA179044OtherUNISON-WMG
PA145116OtherHIGHMARK BLUE SHIELD
PA50057965OtherCAPITAL BLUE CROSS-WMG
PAP002681OtherGATEWAY-WMG
PA50057545OtherKEYSTONE HEALTH PLAN
PA20049267OtherAMERIHEALTH MERCY-WMG
PA2147312OtherMAMSI-WMG
PA36719OtherGEISINGER HEALTH PLAN
PA0068849000OtherAMERIHEALTH 65 PA
PA103030OtherJOHNS HOPKINS
PA4313675OtherAETNA
MD650987OtherCAREFIRST MD BCBS
PA2147312OtherMAMSI-WMG
PA001024858Medicaid
PA145116FLTMedicare PIN