Healthcare Provider Details

I. General information

NPI: 1982529939
Provider Name (Legal Business Name): MADDY CARL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2394 NEW HOLLAND PIKE
LANCASTER PA
17601-5934
US

IV. Provider business mailing address

2394 NEW HOLLAND PIKE
LANCASTER PA
17601-5934
US

V. Phone/Fax

Practice location:
  • Phone: 717-656-4834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: