Healthcare Provider Details

I. General information

NPI: 1386807071
Provider Name (Legal Business Name): LAUREN JODI VAN SCOY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN JODI PITKOW MD

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
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 TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD435503
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD435503
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierMD435503
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerSTATE BOARD OF MEDICINE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: