Healthcare Provider Details

I. General information

NPI: 1902328941
Provider Name (Legal Business Name): UPMC SUSQUEHANNA LOCK HAVEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E CHURCH ST
LOCK HAVEN PA
17745-2025
US

IV. Provider business mailing address

700 HIGH ST
WILLIAMSPORT PA
17701-3100
US

V. Phone/Fax

Practice location:
  • Phone: 570-748-0590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC POHJALA
Title or Position: CFO
Credential:
Phone: 570-321-3175