MEDICARE: ASCELINE SO GO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD066439L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20013114	OTHER	PA	AMERIHEALTH MERCY HANOVER
2	P002764	OTHER	PA	GATEWAY HEALTH PLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	01763401	OTHER	PA	CAPITAL BLUE CROSS/KEYSTO
5	1140783	OTHER	PA	AMERIHEALTH MERCY HANNAH
6	20013109	OTHER	PA	AMERIHEALTH MERCY GEORGE
7	G93617	OTHER	PA	HEALTH AMERICA/HEALTH ASS
8	92962	OTHER	PA	UNITEDHEALTHCARE - GEORGE STREET
9	1147653	OTHER	PA	AMERIHEALTH MERCY LEWISBE
10	737711	OTHER	PA	UPMC
11	350359	OTHER	PA	HIGHMARK BLUE SHIELD
12	115091	OTHER	PA	UNITEDHEALTHCARE - HANNAH PENN

General Provider Information

NPI Number	:	1013955459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASCELINE SO GO M.D.

Provider Business Mailing Address
First Line	:	116 S GEORGE ST
Second Line	:	SUITE 301
City	:	YORK
State	:	PA
Zip	:	17401-1474
Country	:	US
Telephone Number	:	717-801-4821
Fax Number	:	717-854-0377

Provider Business Practice Location Address
First Line	:	116 S GEORGE ST
Second Line	:	SUITE 200
City	:	YORK
State	:	PA
Zip	:	17401-1474
Country	:	US
Telephone Number	:	717-845-8617
Fax Number	:	717-854-6645

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	03/22/2016

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1366483901 — BROOKE LASHER MSPAS, PA-C
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Directions to “ ASCELINE SO GO M.D.” Practice Location

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