MEDICARE: DAWN M RIDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	MD045502L	PA

General Provider Information

NPI Number	:	1750329686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN M RIDER

Provider Business Mailing Address
First Line	:	500 UNIVERSITY DR
Second Line	:
City	:	HERSHEY
State	:	PA
Zip	:	17033-2360
Country	:	US
Telephone Number	:	717-531-1159
Fax Number	:	717-531-0119

Provider Business Practice Location Address
First Line	:	1135 OLDE W CHOCOLATE AVE STE 101
Second Line	:
City	:	HUMMELSTOWN
State	:	PA
Zip	:	17036-9188
Country	:	US
Telephone Number	:	717-531-7010
Fax Number	:	717-531-7102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	01/11/2023

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