Healthcare Provider Details

I. General information

NPI: 1023547163
Provider Name (Legal Business Name): FOTINI DEBONERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2017
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 HARRISBURG PIKE SUITE 312
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2112 HARRISBURG PIKE SUITE 312
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3022
  • Fax: 717-544-3021
Mailing address:
  • Phone: 717-544-3022
  • Fax: 717-544-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD472740
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA11732700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: