Healthcare Provider Details

I. General information

NPI: 1801872908
Provider Name (Legal Business Name): TRISTAN ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 DOCK HILL RD
MIDDLEBURG PA
17842-8910
US

IV. Provider business mailing address

4520 UNION DEPOSIT RD
HARRISBURG PA
17111-2910
US

V. Phone/Fax

Practice location:
  • Phone: 570-837-6617
  • Fax: 570-837-6417
Mailing address:
  • Phone: 717-652-6105
  • Fax: 717-652-2165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL DELOIA
Title or Position: CEO TRISTAN ASSOCIATES
Credential:
Phone: 717-652-6105