Provider Demographics
NPI:1831128941
Name:IMBODEN, ELIZABETH MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARIE
Last Name:IMBODEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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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:717-812-4240
Mailing Address - Fax:717-848-5520
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:STE 100
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-3884
Practice Address - Fax:717-851-3382
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060271L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1142400OtherAH MERCY-WMG QUEEN ST
PA20010049OtherAH MERCY-WMG CARLISLE RD
PA5049566OtherAETNA
PA001631336Medicaid
PA12600OtherGEISINGER
PA249654OtherMAMSI-WMG
PA895449OtherHIGHMARK BLUE SHIELD
PA02185802OtherCAPITAL BLUE CROSS-WMG
PA32672OtherJOHNS HOPKINS
PA80783OtherUNISON-WMG
PAP002870OtherGATEWAY-WMG
PA12600OtherGEISINGER
PA895449FLTMedicare PIN
MD545331OtherCAREFIRST MD BCBS