Provider Demographics
NPI:1619287596
Name:MCCLINTIC, ELYSA AMBER (MD, MS)
Entity Type:Individual
Prefix:
First Name:ELYSA
Middle Name:AMBER
Last Name:MCCLINTIC
Suffix:
Gender:F
Credentials:MD, MS
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Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-887-3241
Practice Address - Fax:570-887-3236
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2021-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY283897207W00000X
PAMD457228207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031356160001Medicaid
NY04506832Medicaid
PA1031356160001Medicaid
PA530070N85Medicare PIN