Organization
BLUE AND GREEN MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NELLY G TEPPER MD (OWNER)
(814) 255-0102
Entity
Organization
Contact information
Practice address
1743 GOUCHER STREET, JOHNSTOWN, PA 15905
(814) 255-0102
(814) 255-0100
Mailing address
PO BOX 819, JOHNSTOWN, PA 15907-0819
(814) 255-0102
(814) 255-0100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD059706L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015959820012
—
PA
01
—
1553821
HIGHMARK GROUP
PA
01
—
883775
HIGHMARK INDIVIDUAL
PA
Enumeration date
05/18/2007
Last updated
08/22/2020
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