Healthcare Provider Details

I. General information

NPI: 1205116274
Provider Name (Legal Business Name): ELIZABETH LONG MATHERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELIZABETH LONG

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 05/08/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MONUMENT RD SUITE 1100
YORK PA
17403-5024
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-2441
  • Fax: 717-851-3521
Mailing address:
  • Phone: 717-851-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA061305
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: