Individual
MARY JO ELINE
Active
Individual
MARY JO ELINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
043603
GA
2085R0202X
Diagnostic Radiology Physician
Primary
OS005976L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000869514C
—
GA
05
—
035832100
—
MD
05
—
102451961
—
PA
01
—
1588746
GATEWAY-WMG
PA
01
—
2502433
HIGHMARK BLUE SHIELD
PA
01
—
30075311
AMERIHEALTH MERCY-WMG
PA
01
—
301200
UNISON-WMG
PA
01
—
751227
UPMC-WMG
PA
01
—
919374
CAREFIRST BCBS
MD
Enumeration date
12/21/2005
Last updated
06/30/2016
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