Provider Demographics
NPI:1811983927
Name:ETTLINGER, ROBERT ALAN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:ETTLINGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:36 S RIVER RD
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:PA
Practice Address - Zip Code:17032-8614
Practice Address - Country:US
Practice Address - Phone:717-827-3428
Practice Address - Fax:717-827-3437
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2022-04-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD027460E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009483900010Medicaid
PA0009483900008Medicaid
PA0009483900009Medicaid