Healthcare Provider Details

I. General information

NPI: 1639176449
Provider Name (Legal Business Name): MICHAEL A ZITTLE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/23/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 HARRISBURG ST
EAST BERLIN PA
17316-9505
US

IV. Provider business mailing address

312 HARRISBURG ST
EAST BERLIN PA
17316-9505
US

V. Phone/Fax

Practice location:
  • Phone: 717-259-0222
  • Fax: 717-259-6348
Mailing address:
  • Phone: 717-259-0222
  • Fax: 717-259-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS003185L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: