Healthcare Provider Details

I. General information

NPI: 1568044352
Provider Name (Legal Business Name): TYLER WALBURN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONDONDERRY RD LOWR LEVEL
HARRISBURG PA
17109-5317
US

IV. Provider business mailing address

4300 LONDONDERRY RD
HARRISBURG PA
17109-5317
US

V. Phone/Fax

Practice location:
  • Phone: 717-724-6740
  • Fax: 717-724-6741
Mailing address:
  • Phone: 717-960-3750
  • Fax: 717-960-3734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD493760
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: