Basic Information
| Provider Information | |||||||||
| NPI: | 1861862591 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERNISTS OF CENTRAL PENNSYLVANIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 154 ERFORD RD APT 405 | ||||||||
| Address2: | |||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170111827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405043140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 108 LOWTHER ST | ||||||||
| Address2: | |||||||||
| City: | LEMOYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170432045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177741366 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2015 | ||||||||
| LastUpdateDate: | 10/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | GEORGIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7177741366 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA057852 | PA | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | MA057852 | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.