Healthcare Provider Details

I. General information

NPI: 1750139432
Provider Name (Legal Business Name): ELIZABETH PAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S GEORGE ST
YORK PA
17403-3676
US

IV. Provider business mailing address

1001 S GEORGE ST
YORK PA
17403-3676
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-2427
  • Fax:
Mailing address:
  • Phone: 717-851-2427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT231352
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: