Provider Demographics
NPI:1336178615
Name:ELLSWORTH, BETTINA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTINA
Middle Name:MARIE
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETTINA
Other - Middle Name:MARIE GROOME
Other - Last Name:OHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:993 LONG LN
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-2920
Mailing Address - Country:US
Mailing Address - Phone:717-334-6068
Mailing Address - Fax:
Practice Address - Street 1:993 LONG LN
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2920
Practice Address - Country:US
Practice Address - Phone:717-334-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027671E207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000876100Medicaid
PA104609OtherJOHNS HOPKINS
PA4244528OtherAETNA
PA150863OtherHIGHMARK BLUE SHIELD
MD132151001Medicaid
PA38221OtherGEISINGER
PA150863FLTMedicare PIN
PAB39953Medicare UPIN
PA38221OtherGEISINGER