Healthcare Provider Details

I. General information

NPI: 1457631467
Provider Name (Legal Business Name): ELENA GEORGIEVSKAYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 HECKEL RD STE 200
MC KEES ROCKS PA
15136-1673
US

IV. Provider business mailing address

114 MAPLEWOOD DR
BEAVER PA
15009-1337
US

V. Phone/Fax

Practice location:
  • Phone: 412-262-4694
  • Fax: 412-262-5920
Mailing address:
  • Phone: 412-925-4515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD427861
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: