Healthcare Provider Details

I. General information

NPI: 1235969171
Provider Name (Legal Business Name): CONCERTOCARE MEDICAL GROUP OF PENNSYLVANIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 SIMPSON FERRY RD STE 100
CAMP HILL PA
17011-6405
US

IV. Provider business mailing address

PO BOX 801280
KANSAS CITY MO
64180-1280
US

V. Phone/Fax

Practice location:
  • Phone: 717-256-2425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JACOB WASAG
Title or Position: MARKET MEDICAL DIRECTOR
Credential: MD
Phone: 980-220-2283