Healthcare Provider Details

I. General information

NPI: 1104886175
Provider Name (Legal Business Name): DONNA L BROSBE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 NOLL DRIVE, SUITE 100
LANCASTER PA
17603
US

IV. Provider business mailing address

2150 NOLL DRIVE, SUITE 100
LANCASTER PA
17603
US

V. Phone/Fax

Practice location:
  • Phone: 717-299-8933
  • Fax: 717-299-5635
Mailing address:
  • Phone: 717-299-8933
  • Fax: 717-299-5635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD026059E
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier001298370
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier01429701
Identifier TypeOTHER
Identifier StatePW
Identifier IssuerCAPITAL BLUE CROSS ID
# 3
Identifier35877
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUESHIELD ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: