Provider Demographics
NPI:1770527673
Name:GALL, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16550-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2657067OtherOH MEDICAL ASSISTANCE
NY00027604801OtherUNIVERA
NY02771644OtherNY MEDICAL ASSISTANCE
PA1861441OtherBLUE SHIELD
WV1069717OtherW. VIRGINIA WORKERS COMP
PA1334469OtherAETNA
PA1016186220001Medicaid
PA188150OtherUNISON
PA718515OtherUPMC
PA1553973OtherGATEWAY
PAP00342853OtherRR MEDICARE
PA1861441OtherBLUE SHIELD
PAP00342853OtherRR MEDICARE