Healthcare Provider Details

I. General information

NPI: 1558306670
Provider Name (Legal Business Name): PETER A HURTUBISE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 HIGHLANDS DR STE 100
LITITZ PA
17543-7681
US

IV. Provider business mailing address

1535 HIGHLANDS DR STE 100
LITITZ PA
17543-7681
US

V. Phone/Fax

Practice location:
  • Phone: 717-627-4088
  • Fax: 717-627-4089
Mailing address:
  • Phone: 717-627-4088
  • Fax: 717-627-4089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS009749L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier001666162
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: