Basic Information
| Provider Information | |||||||||
| NPI: | 1851583504 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINNACLEHEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 304 MARY ST | ||||||||
| Address2: | 95 | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171043534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172130244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 S FRONT ST | ||||||||
| Address2: | BRADY 3RD FLOOR | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171041619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172318508 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2007 | ||||||||
| LastUpdateDate: | 08/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | GOLDMAN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR INTERNAL MEDICINE | ||||||||
| AuthorizedOfficialTelephone: | 7172318508 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | MT 185306 | PA | Y | Hospitals | General Acute Care Hospital |
No ID Information.