Provider Demographics
NPI:1104820968
Name:DELAVERIS, STEVEN L (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:DELAVERIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-4005
Mailing Address - Fax:717-812-2495
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-4005
Practice Address - Fax:717-812-2495
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002980207Q00000X
PAOS015993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30138237OtherAMERIHEALTH MERCY-WMG
PAP011615OtherGATEWAY
OH0426319Medicaid
PA102760930Medicaid
PA1612045OtherGATEWAY
PA30138238OtherAMERIHEALTH MERCY-WMG
PA730183OtherHIGHMARK BLUE SHIELD
PA418789OtherUPMC
OH0426319Medicaid
PA249102EZ3Medicare PIN
PAP011615OtherGATEWAY
PA249102FLTMedicare PIN