Healthcare Provider Details

I. General information

NPI: 1578826269
Provider Name (Legal Business Name): JUSTIN OVERCASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N DUKE ST
LANCASTER PA
17602-2250
US

IV. Provider business mailing address

PO BOX 4216
LANCASTER PA
17604-4216
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-4900
  • Fax: 717-544-5907
Mailing address:
  • Phone: 717-394-6028
  • Fax: 717-509-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT202097
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD464201
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: