Healthcare Provider Details

I. General information

NPI: 1366438301
Provider Name (Legal Business Name): CRAIG ERNST PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N FRONT ST
WORMLEYSBURG PA
17043-1034
US

IV. Provider business mailing address

1000 N FRONT ST
WORMLEYSBURG PA
17043-1034
US

V. Phone/Fax

Practice location:
  • Phone: 717-731-0101
  • Fax: 717-441-0592
Mailing address:
  • Phone: 717-731-0101
  • Fax: 717-441-0592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA050834
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: