1013955459 NPI number — ASCELINE SO GO M.D.

Table of content: (NPI 1871200477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013955459 NPI number — ASCELINE SO GO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GO
Provider First Name:
ASCELINE
Provider Middle Name:
SO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013955459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 S GEORGE ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17401-1474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-801-4821
Provider Business Mailing Address Fax Number:
717-854-0377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 S GEORGE ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17401-1474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-845-8617
Provider Business Practice Location Address Fax Number:
717-854-6645
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD066439L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20013114 . This is a "AMERIHEALTH MERCY HANOVER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P002764 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001743806 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01763401 . This is a "CAPITAL BLUE CROSS/KEYSTO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1140783 . This is a "AMERIHEALTH MERCY HANNAH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20013109 . This is a "AMERIHEALTH MERCY GEORGE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: G93617 . This is a "HEALTH AMERICA/HEALTH ASS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 92962 . This is a "UNITEDHEALTHCARE - GEORGE STREET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1147653 . This is a "AMERIHEALTH MERCY LEWISBE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 737711 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 350359 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 115091 . This is a "UNITEDHEALTHCARE - HANNAH PENN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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