Healthcare Provider Details

I. General information

NPI: 1548657141
Provider Name (Legal Business Name): QUANTUM IMAGING AND THERAPEUTIC ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629D LOWTHER RD
LEWISBERRY PA
17339-9527
US

IV. Provider business mailing address

629D LOWTHER RD
LEWISBERRY PA
17339-9527
US

V. Phone/Fax

Practice location:
  • Phone: 717-932-5200
  • Fax: 717-932-3095
Mailing address:
  • Phone: 717-932-5200
  • Fax: 717-932-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH A BERGEY
Title or Position: PRESIDENT AND CEO
Credential: M.D
Phone: 717-932-5200