Healthcare Provider Details

I. General information

NPI: 1316063126
Provider Name (Legal Business Name): THE PENNSYLVANIA STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 EISENHOWER RD. 308 STUDENT HEALTH CENTER
UNIVERSITY PARK PA
16802-2129
US

IV. Provider business mailing address

308 STUDENT HEALTH CTR
UNIVERSITY PARK PA
16802-2129
US

V. Phone/Fax

Practice location:
  • Phone: 814-865-4847
  • Fax: 814-865-7778
Mailing address:
  • Phone: 814-865-3465
  • Fax: 814-865-7778

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 Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. NATAHSHA BAUMGARTNER
Title or Position: ASST. DIRECTOR OF UHS OPERATIONS
Credential:
Phone: 814-865-4847