Provider Demographics
NPI:1407840283
Name:LEWISBURG PEDIATRICS
Entity Type:Organization
Organization Name:LEWISBURG PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:STOLTZFUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-523-3264
Mailing Address - Street 1:55 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-6343
Mailing Address - Country:US
Mailing Address - Phone:570-523-3264
Mailing Address - Fax:570-523-3465
Practice Address - Street 1:55 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6343
Practice Address - Country:US
Practice Address - Phone:570-523-3264
Practice Address - Fax:570-523-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008830340003Medicaid