Provider Demographics
NPI:1669439428
Name:DEIBERT, ELLEN M (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:DEIBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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:717-851-5503
Mailing Address - Fax:717-851-5507
Practice Address - Street 1:1695 ROOSEVELT AVE STE B
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-8521
Practice Address - Country:US
Practice Address - Phone:717-851-5503
Practice Address - Fax:717-798-3510
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4498702084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102862232Medicaid
MA2019663Medicaid
PA2984321OtherHIGHMARK BLUE SHIELD
A26045Medicare ID - Type Unspecified
MA2019663Medicaid
PA102862232Medicaid