Basic Information
| Provider Information | |||||||||
| NPI: | 1023071677 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEPALMA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | GERARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.A.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2201 BRUNSWICK DR STE 1200 | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173318350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176370470 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2201 BRUNSWICK DR STE 1200 | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173318350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176370470 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 01/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | MA051333 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 2696619 | 01 | PA | HIGHMARK BLUE SHIELD - FREEDOM BLUE | OTHER | 1587595 | 01 | PA | GATEWAY MEDICARE ASSURED | OTHER |