Healthcare Provider Details

I. General information

NPI: 1336386408
Provider Name (Legal Business Name): THE MILTON S. HERSHEY MEDICAL CENTER PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 NORTHEAST DR
HERSHEY PA
17033-2732
US

IV. Provider business mailing address

PO BOX 858
HERSHEY PA
17033-0858
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-1455
  • Fax:
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number05029
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier05029
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerDEPT OF HEALTH FACILITY LICENSE NUMBER

VIII. Authorized Official

Name: DONALD MCKENNA
Title or Position: PRESIDENT
Credential:
Phone: 717-531-3979