MEDICARE: GELA G MCHEDLISHVILI MD

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	207R00000X	Internal Medicine Physician	MD063153L	PA
2	207RN0300X	Nephrology Physician	MD063153L	PA
3	207RN0300X	Nephrology Physician	C143015	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	20067552	OTHER	PA	AMERIHEALTH MERCY-WMG
3	2167388	OTHER	PA	MAMSI-WMG
4	9566069	OTHER	PA	AETNA
5	1567154	OTHER	PA	GATEWAY-WMG
6	1978152	OTHER	PA	HIGHMARK BLUE SHIELD
7	111166	OTHER	PA	GEISINGER
8	211714	OTHER	PA	JOHNS HOPKINS
9	900186	OTHER	MD	CAREFIRST MD BCBS
10	220419	OTHER	PA	UNISON-WMG
11	50071495	OTHER	PA	CAPITAL BLUE CROSS-WMG

General Provider Information

NPI Number	:	1942418017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GELA G MCHEDLISHVILI MD

Provider Business Mailing Address
First Line	:	3421 CONCORD RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-9001
Country	:	US
Telephone Number	:	717-851-6040
Fax Number	:	717-851-3190

Provider Business Practice Location Address
First Line	:	12660 RIVERSIDE DR STE 215
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91607-3430
Country	:	US
Telephone Number	:	818-487-0040
Fax Number	:

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

Provider Enumeration Date	:	05/20/2007
Last Update Date	:	02/19/2020

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