Provider Demographics
NPI:1336183631
Name:BRELVI, JOANNA E (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:E
Last Name:BRELVI
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 1:4131 OREGON PIKE
Mailing Address - Street 2:SUITE C
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-9550
Mailing Address - Country:US
Mailing Address - Phone:717-859-5161
Mailing Address - Fax:717-859-5169
Practice Address - Street 1:30 W. SWARTZVILLE ROAD
Practice Address - Street 2:
Practice Address - City:REINHOLDS
Practice Address - State:PA
Practice Address - Zip Code:17569-9641
Practice Address - Country:US
Practice Address - Phone:717-484-4347
Practice Address - Fax:717-484-0968
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013641640001Medicaid
PABR1765862OtherBLUE SHIELD
PA1013641640001Medicaid
PAF81241Medicare UPIN