Basic Information
| Provider Information | |||||||||
| NPI: | 1356334874 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLMSTEAD | ||||||||
| FirstName: | P | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4520 UNION DEPOSIT RD | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171112910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176526105 | ||||||||
| FaxNumber: | 7176522165 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 SOUTH FRONT STREET | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171118700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177825640 | ||||||||
| FaxNumber: | 7177825352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 01/25/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | MD028503E | PA | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZP0101X | MD028503E | PA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0009113170005 | 05 | PA | MEDICAID | 0009118170001 | 05 | PA | MEDICAID |