Basic Information
| Provider Information | |||||||||
| NPI: | 1033143367 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKINNER | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SKINNER | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1 ATWELL RD | ||||||||
| Address2: | |||||||||
| City: | COOPERSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133261301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075473480 | ||||||||
| FaxNumber: | 6075475034 | ||||||||
| Practice Location | |||||||||
| Address1: | 2031 DREAM CATCHER PLZ | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134212729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152315400 | ||||||||
| FaxNumber: | 3153633540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS009192L | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 288899 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102823 | 01 | PA | JOHNS HOPKINS | OTHER | 176515 | 01 | PA | UNISON-WMG | OTHER | 30113686 | 01 | PA | AMERIHEALTH MERCY - WMG | OTHER | 2143925 | 01 | PA | MAMSI-WMG | OTHER | P006960 | 01 | PA | GATEWAY-WMG | OTHER | 101479135 | 05 | PA | MEDICAID | 50056184 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 648850 | 01 | MD | CAREFIRST MD BCBS | OTHER | 20049247 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 7107910 | 01 | PA | AETNA | OTHER | 100486 | 01 | PA | GEISINGER | OTHER | 1804786 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |