Provider Demographics
NPI:1720305337
Name:WIEST, ELIZABETH L (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:WIEST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4218
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-267-7146
Practice Address - Fax:717-267-7728
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013520207P00000X
PAOS016484207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102818691 0002Medicaid
PA1621594OtherGATEWAY
PA102818691 0001Medicaid
PA2897727OtherHIGHMARK BLUE SHIELD
PA102818691Medicaid
PA285430EZ3Medicare PIN
PA285430GZ5Medicare PIN
PA285430G0EMedicare PIN