Healthcare Provider Details

I. General information

NPI: 1578218681
Provider Name (Legal Business Name): ELAINE ISABEL MELLINGER PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELAINE ISABEL RAFFUCCI

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W FULTON ST
EPHRATA PA
17522-1902
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-721-8789
  • Fax: 717-715-1360
Mailing address:
  • Phone: 717-721-8789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA063898
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: