Basic Information
| Provider Information | |||||||||
| NPI: | 1831154178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HURSH | ||||||||
| FirstName: | DALE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2110 HARRISBURG PIKE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175443022 | ||||||||
| FaxNumber: | 7175443021 | ||||||||
| Practice Location | |||||||||
| Address1: | 2110 HARRISBURG PIKE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175443022 | ||||||||
| FaxNumber: | 7175443021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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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 | 207QG0300X | MD044649L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000718505 | 01 | PA | HIGHMARK | OTHER | 1417248 | 01 | PA | AETNA-HMO | OTHER | 2069914 | 01 | PA | MERCY | OTHER | 40246 | 01 | PA | GEISINGER | OTHER | 50055979 | 01 | PA | CAPITAL BLUE CROSS | OTHER | P002392 | 01 | PA | GATEWAY | OTHER | 080174701 | 01 | PA | RR MEDICARE | OTHER | 5495042 | 01 | PA | AETNA-NON HMO | OTHER | 001279338 0014 | 05 | PA | MEDICAID | 0555449000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 2069914 | 01 | PA | UNISON | OTHER | 50055979 | 01 | PA | KEYSTONE HEALTH PLAN CENTRAL | OTHER |