Healthcare Provider Details

I. General information

NPI: 1659867620
Provider Name (Legal Business Name): JOSHUA DAVID ETZEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
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:
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 NumberOS020277
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOT018261
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: