Provider Demographics
NPI:1942418017
Name:MCHEDLISHVILI, GELA G (MD)
Entity Type:Individual
Prefix:
First Name:GELA
Middle Name:G
Last Name:MCHEDLISHVILI
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 1:3421 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:717-851-6040
Mailing Address - Fax:717-851-3190
Practice Address - Street 1:12660 RIVERSIDE DR STE 215
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-3430
Practice Address - Country:US
Practice Address - Phone:818-487-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063153L207R00000X, 207RN0300X
CAC143015207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101971303Medicaid
PA20067552OtherAMERIHEALTH MERCY-WMG
PA2167388OtherMAMSI-WMG
PA9566069OtherAETNA
PA1567154OtherGATEWAY-WMG
PA1978152OtherHIGHMARK BLUE SHIELD
PA111166OtherGEISINGER
PA211714OtherJOHNS HOPKINS
MD900186OtherCAREFIRST MD BCBS
PA220419OtherUNISON-WMG
PA50071495OtherCAPITAL BLUE CROSS-WMG
MD900186OtherCAREFIRST MD BCBS
PA101971303Medicaid
PAP00422327Medicare PIN