MEDICARE: DOUGLAS AVERY & ASSOCIATES, LTD

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	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962888370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS AVERY & ASSOCIATES, LTD

Provider Business Mailing Address
First Line	:	4714 GETTYSBURG RD
Second Line	:
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-972-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	8926 CHESAPEAKE AVE STE A
Second Line	:
City	:	NORTH BEACH
State	:	MD
Zip	:	20714-4050
Country	:	US
Telephone Number	:	410-289-3341
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MICHAEL E TARVIN
Credential	:
Telephone Number	:	717-972-1100

Provider Enumeration Date	:	08/07/2015
Last Update Date	:	08/21/2024

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