Provider Demographics
NPI:1841473980
Name:WALLO, ELISE ANN (MD)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:ANN
Last Name:WALLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 S GEORGE ST
Mailing Address - Street 2:YORK HOSPITAL DEPARTMENT OF EMERGENCY MEDICINE
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3676
Mailing Address - Country:US
Mailing Address - Phone:717-851-2450
Mailing Address - Fax:
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:YORK HOSPITAL DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT185835207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine