Healthcare Provider Details

I. General information

NPI: 1801886262
Provider Name (Legal Business Name): ADAM CHARLES MAGNUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S 5TH AVE
WEST READING PA
19611-2143
US

IV. Provider business mailing address

HANOVER ANESTHESIA AND PAIN MANAGEMENT 250 FAME AVENUE # 110
HANOVER PA
17331
US

V. Phone/Fax

Practice location:
  • Phone: 484-628-8269
  • Fax:
Mailing address:
  • Phone: 717-632-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0057163
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD0057163
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD436288
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: