Healthcare Provider Details

I. General information

NPI: 1912295056
Provider Name (Legal Business Name): EMILY THERESE HAGGERTY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY THERESE ZELINKA

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 10/25/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S 4TH ST
LEBANON PA
17042-6111
US

IV. Provider business mailing address

601 MEMORY LANE
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-7866
  • Fax: 717-270-3790
Mailing address:
  • Phone: 717-851-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA054954
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: