Basic Information
| Provider Information | |||||||||
| NPI: | 1053384032 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YELCICK | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175445511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175445511 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 03/30/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246Q00000X | MD058018L | PA | Y | Technologists, Technicians & Other Technical Service Providers | Spec/Tech, Pathology |
ID Information
| ID | Type | State | Issuer | Description | 001557990 | 05 | PA | MEDICAID | 2411767000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 001746389 | 01 | PA | HIGHMARK | OTHER | P00249598 | 01 | PA | RR MEDICARE | OTHER | 50056067 | 01 | PA | CAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL | OTHER | 000000179730 | 01 | PA | UNISON | OTHER | 2375 | 01 | PA | GEISINGER | OTHER | 1150039 | 01 | PA | AETNA-HMO | OTHER | 1551103 | 01 | PA | GATEWAY | OTHER | 20044837 | 01 | PA | MERCY | OTHER | 5515093 | 01 | PA | AETNA-NON HMO | OTHER |