Healthcare Provider Details

I. General information

NPI: 1093944779
Provider Name (Legal Business Name): HANOVER HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HIGHLAND AVENUE
HANOVER PA
17331-2297
US

IV. Provider business mailing address

300 HIGHLAND AVENUE
HANOVER PA
17331-2297
US

V. Phone/Fax

Practice location:
  • Phone: 717-637-3711
  • Fax: 717-646-0188
Mailing address:
  • Phone: 717-316-3711
  • Fax: 717-646-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StatePA

VIII. Authorized Official

Name: MICHAEL W GASKINS
Title or Position: INTERIM CEO/CFO
Credential:
Phone: 717-316-2153