Organization
RUSSEL H. ETTER MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA S WOLFGANG (OFFICE MANAGER)
(717) 741-3896
Entity
Organization
Contact information
Practice address
55 WYNTRE BROOKE DR, YORK, PA 17403-4536
(717) 741-3896
(717) 741-5434
Mailing address
55 WYNTRE BROOKE DR, YORK, PA 17403-4536
(717) 741-3896
(717) 741-5434
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD008050E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000018534
HIGHMARK BLUE SHIELD
PA
01
—
0004626999
AETNA
PA
01
—
03206000
CAPITAL BLUE CROSS
PA
05
—
0643575
—
PA
01
—
172355
HEALTHAMERICAN PA
PA
01
—
8110175
CIGNA
PA
Enumeration date
01/30/2007
Last updated
11/05/2009
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