Healthcare Provider Details

I. General information

NPI: 1134246838
Provider Name (Legal Business Name): SUSAN M KORCH-APPLEBY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 W GOVERNOR RD
HERSHEY PA
17033-2074
US

IV. Provider business mailing address

357 W GOVERNOR RD
HERSHEY PA
17033-2074
US

V. Phone/Fax

Practice location:
  • Phone: 717-533-7400
  • Fax: 717-533-7402
Mailing address:
  • Phone: 717-533-7400
  • Fax: 717-533-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS030526L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: