Healthcare Provider Details

I. General information

NPI: 1740373364
Provider Name (Legal Business Name): HANOVER FOOT AND ANKLE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 FAME AVENUE SUITE 220
HANOVER PA
17331-1587
US

IV. Provider business mailing address

250 FAME AVENUE SUITE 220
HANOVER PA
17331-1587
US

V. Phone/Fax

Practice location:
  • Phone: 717-632-5264
  • Fax: 717-632-1165
Mailing address:
  • Phone: 717-632-5264
  • Fax: 717-632-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC003296L
License Number StatePA

VIII. Authorized Official

Name: DOUGLAS PAUL SHEEHAN I
Title or Position: OWNER
Credential: DPM
Phone: 717-632-5264