Basic Information
| Provider Information | |||||||||
| NPI: | 1295786622 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL PA EMERGENCY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 WITMER RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | HORSHAM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190442211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154425051 | ||||||||
| FaxNumber: | 2159572875 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 RURAL AVE | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 177013109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703212000 | ||||||||
| FaxNumber: | 5703212018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | SENULA | ||||||||
| AuthorizedOfficialFirstName: | GERHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5703212000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0019701160001 | 05 | PA | MEDICAID | 1500288 | 01 | PA | BLUE SHIELD | OTHER |