Provider Demographics
NPI:1578218681
Name:MELLINGER, ELAINE ISABEL (PAC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:ISABEL
Last Name:MELLINGER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:ISABEL
Other - Last Name:RAFFUCCI
Other - Suffix:
Other - Last Name Type:Former 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:717-721-8789
Mailing Address - Fax:
Practice Address - Street 1:207 W FULTON ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1902
Practice Address - Country:US
Practice Address - Phone:717-721-8789
Practice Address - Fax:717-715-1360
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMA063898363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program