Provider Demographics
NPI:1912129958
Name:BLAIN, ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BLAIN
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 1:3421 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:717-851-7315
Mailing Address - Fax:717-741-3056
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8200
Practice Address - Country:US
Practice Address - Phone:717-851-7315
Practice Address - Fax:717-741-3056
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015177207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD966173-01OtherCAREFIRST MD BCBS-WMG
PA1024723260001Medicaid
PAP010232OtherGATEWAY-WMG
PA2508849OtherHIGHMARK BLUE SHIELD
PA415273OtherUPMC-WMG
PA30080180OtherAMERIHEALTH MERCY-WMG
PA303065OtherUNISON-WMG
PAP010232OtherGATEWAY-WMG
PA415273OtherUPMC-WMG