Healthcare Provider Details

I. General information

NPI: 1073574257
Provider Name (Legal Business Name): JORGE M DIDUSZYN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 CARLISLE PIKE
CAMP HILL PA
17011-4132
US

IV. Provider business mailing address

4400 CARLISLE PIKE
CAMP HILL PA
17011-4132
US

V. Phone/Fax

Practice location:
  • Phone: 717-975-9800
  • Fax: 717-975-5509
Mailing address:
  • Phone: 717-975-9800
  • Fax: 717-975-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD427818
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD427818
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: