Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | MD027671E | PA |
NPI | 1336178615 |
---|---|
Provider Name | Dr. Bettina Marie Ellsworth |
First Address | Gettysburg, PA 17325-2920 |
Second Address | Gettysburg, PA 17325-2920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 05/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000876100 | (05) | PA |
104609 | JOHNS HOPKINS (01) | PA |
132151001 | (05) | MD |
150863 | HIGHMARK BLUE SHIELD (01) | PA |
38221 | GEISINGER (01) | PA |
4244528 | AETNA (01) | PA |
B39953 | (02) | PA |