| State Stree Family Practice | |
|
11 S State St Ephrata PA 17522-2410 | |
| (717) 733-4559 | |
| Not Available |
| Full Name | State Stree Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 11 S State St, Ephrata, Pennsylvania |
| Authorized Official Name and Position | Cynthia Malizia (VP NLCMG) |
| Authorized Official Contact | 7177382280 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Stree Family Practice Po Box 398 Brownstown PA 17508-0398 Ph: (717) 859-2038 | State Stree Family Practice 11 S State St Ephrata PA 17522-2410 Ph: (717) 733-4559 |
| NPI Number | 1538107560 |
|---|---|
| Provider Enumeration Date | 06/03/2006 |
| Last Update Date | 04/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538107560 | NPI | - | NPPES |
| 1013977730012 | Medicaid | PA | |
| 50051253 | Other | PA | BLUE CROSS |
| 7090090 | Other | PA | AETNA |
| DD6938 | Other | PA | RR MEDICARE |
| 1746355 | Other | PA | BLUE SHIELD |
| 1517100 | Other | PA | GATEWAY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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