Healthcare Provider Details

I. General information

NPI: 1679708374
Provider Name (Legal Business Name): HENRY CHRISTIAN QUEVEDO DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HENRY CHRISTIAN QUEVEDO M.D.

II. Dates (important events)

Enumeration Date: 05/25/2009
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 ST PAUL DR
CHAMBERSBURG PA
17201-1035
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-217-6886
  • Fax: 717-217-6896
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.205735
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberDR.0072323
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD466350
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: