Provider Demographics
NPI:1609076165
Name:PFEIFFER, MARYELLEN ESTEVEZ (DO)
Entity Type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:ESTEVEZ
Last Name:PFEIFFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARYELLEN
Other - Middle Name:E
Other - Last Name:ESTEVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1001 S GEORGE ST
Mailing Address - Street 2:FL 4
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3676
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-4005
Practice Address - Fax:717-812-2495
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013949208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1582461OtherGATEWAY-WMG
MD033831100Medicaid
PA2109718OtherHIGHMARK BLUE SHIELD
PA30131964OtherAMERIHEALTH MERCY - WMG
MD953500OtherCAREFIRST MD BCBS-WMG
PA20091168OtherAMERIHEALTH MERCY-WMG
PA272755OtherUNISON-WMG
PA102179302Medicaid
PA129271EZ3Medicare PIN
MD953500OtherCAREFIRST MD BCBS-WMG
PA2109718OtherHIGHMARK BLUE SHIELD