Provider Demographics
NPI:1811195464
Name:ELLIOTT, RIVER MCKENZIE (MD)
Entity Type:Individual
Prefix:
First Name:RIVER
Middle Name:MCKENZIE
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 POWDER MILL RD
Mailing Address - Street 2:ATTN MEDICAL STAFF OFFICE
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4723
Mailing Address - Country:US
Mailing Address - Phone:717-718-2000
Mailing Address - Fax:
Practice Address - Street 1:1855 POWDER MILL RD
Practice Address - Street 2:OSS HEALTH
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4723
Practice Address - Country:US
Practice Address - Phone:717-848-4800
Practice Address - Fax:717-741-9867
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4402802082S0105X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102937208Medicaid
353237YFB7Medicare PIN