Provider Demographics
NPI:1801289483
Name:WARGO, ELIZABETH (LDN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WARGO
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:FOLEY
Other - Suffix:
Other - Last Name Type:Former Name
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:717-339-2475
Mailing Address - Fax:717-339-2438
Practice Address - Street 1:450 S WASHINGTON ST STE B1
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2500
Practice Address - Country:US
Practice Address - Phone:717-339-2475
Practice Address - Fax:717-339-2438
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001940133V00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP01585207Medicare PIN
PA405217FLTMedicare PIN