Healthcare Provider Details

I. General information

NPI: 1124683776
Provider Name (Legal Business Name): PENNSYLVANIA SURGICAL PROVIDERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 S ARLINGTON AVE
HARRISBURG PA
17109-5004
US

IV. Provider business mailing address

875 S ARLINGTON AVE
HARRISBURG PA
17109-5004
US

V. Phone/Fax

Practice location:
  • Phone: 717-652-1107
  • Fax: 717-652-1142
Mailing address:
  • Phone: 717-652-1107
  • Fax: 717-652-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NOELE A PETERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 717-652-1107