Healthcare Provider Details

I. General information

NPI: 1083251458
Provider Name (Legal Business Name): KONRAD W HERSHEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 COLUMBIA AVE
LANCASTER PA
17603-3633
US

IV. Provider business mailing address

1800 VILLAGE CIR
LANCASTER PA
17603-2376
US

V. Phone/Fax

Practice location:
  • Phone: 717-951-3212
  • Fax:
Mailing address:
  • Phone: 717-874-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: