Healthcare Provider Details

I. General information

NPI: 1730529108
Provider Name (Legal Business Name): JORGE LUIS ESCOBAR VALLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 POPLAR CHURCH RD STE 400
CAMP HILL PA
17011-2203
US

IV. Provider business mailing address

PO BOX 848
HERSHEY PA
17033-0848
US

V. Phone/Fax

Practice location:
  • Phone: 610-208-8818
  • Fax: 717-214-1068
Mailing address:
  • Phone: 610-208-8818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number256356
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD22671
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD487089
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: