Healthcare Provider Details

I. General information

NPI: 1356334874
Provider Name (Legal Business Name): P MICHAEL OLMSTEAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SOUTH FRONT STREET
HARRISBURG PA
17111-8700
US

IV. Provider business mailing address

4520 UNION DEPOSIT RD
HARRISBURG PA
17111-2910
US

V. Phone/Fax

Practice location:
  • Phone: 717-782-5640
  • Fax: 717-782-5352
Mailing address:
  • Phone: 717-652-6105
  • Fax: 717-652-2165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD028503E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD028503E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: