Healthcare Provider Details

I. General information

NPI: 1659696714
Provider Name (Legal Business Name): DANIEL J CHURCH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 GOOD HOPE RD
ENOLA PA
17025-1233
US

IV. Provider business mailing address

1830 GOOD HOPE RD
ENOLA PA
17025-1233
US

V. Phone/Fax

Practice location:
  • Phone: 717-988-8135
  • Fax: 717-221-5600
Mailing address:
  • Phone: 717-988-8135
  • Fax: 717-221-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA054295
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMA054295
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: