Provider Demographics
NPI:1053384032
Name:YELCICK, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:YELCICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058018L246Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001557990Medicaid
PA2411767000OtherINDEPENDENCE BLUE CROSS
PA001746389OtherHIGHMARK
PAP00249598OtherRR MEDICARE
PA50056067OtherCAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL
PA000000179730OtherUNISON
PA2375OtherGEISINGER
PA1150039OtherAETNA-HMO
PA1551103OtherGATEWAY
PA20044837OtherMERCY
PA5515093OtherAETNA-NON HMO
PAP00249598OtherRR MEDICARE
PAG20863Medicare UPIN