Basic Information
| Provider Information | |||||||||
| NPI: | 1083991814 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHIMP | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STEWART | ||||||||
| OtherFirstName: | MARY | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1404 BALTIMORE ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173318698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176370470 | ||||||||
| FaxNumber: | 7176374987 | ||||||||
| Practice Location | |||||||||
| Address1: | 416 N BROAD ST | ||||||||
| Address2: | |||||||||
| City: | EMPORIUM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158341402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144862202 | ||||||||
| FaxNumber: | 8147884616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2011 | ||||||||
| LastUpdateDate: | 11/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA055195 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.