Healthcare Provider Details

I. General information

NPI: 1003698838
Provider Name (Legal Business Name): PATHOLOGY ASSOCIATES OF CUMBERLAND VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N 21ST ST
CAMP HILL PA
17011-2204
US

IV. Provider business mailing address

PO BOX 696
WICHITA KS
67201-0696
US

V. Phone/Fax

Practice location:
  • Phone: 800-475-6236
  • Fax: 706-653-4449
Mailing address:
  • Phone: 800-475-6236
  • Fax: 706-653-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: LAILA KING
Title or Position: CLIENT ANALYST
Credential:
Phone: 800-475-6236