Healthcare Provider Details

I. General information

NPI: 1104846823
Provider Name (Legal Business Name): PATRICK C MA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR MC A410
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

PO BOX 858 MC A410
HERSHEY PA
17033-0858
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-6585
  • Fax: 717-531-0429
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35-087260
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD468236
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier000000224352
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerUNISON
# 2
Identifier000000539587
Identifier TypeOTHER
Identifier State
Identifier IssuerANTHEM
# 3
Identifier741844
Identifier TypeOTHER
Identifier State
Identifier IssuerBUCKEYE
# 4
Identifier363789
Identifier TypeOTHER
Identifier State
Identifier IssuerWELLCARE
# 5
Identifier2622791
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 6
Identifier7877791
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: