Healthcare Provider Details

I. General information

NPI: 1891721064
Provider Name (Legal Business Name): HANOVER PEDIATRIC ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 BROADWAY
HANOVER PA
17331-2503
US

IV. Provider business mailing address

217 BROADWAY
HANOVER PA
17331-2503
US

V. Phone/Fax

Practice location:
  • Phone: 717-632-8944
  • Fax: 717-632-1224
Mailing address:
  • Phone: 717-632-8944
  • Fax: 717-632-1224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS JOSEPH MASUCCI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 717-632-8944