Healthcare Provider Details

I. General information

NPI: 1578518015
Provider Name (Legal Business Name): MD AT HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 KINGSTON RD SUITE 205
YORK PA
17402-3735
US

IV. Provider business mailing address

2550 KINGSTON RD SUITE 205
YORK PA
17402-3735
US

V. Phone/Fax

Practice location:
  • Phone: 717-840-4646
  • Fax: 717-840-8686
Mailing address:
  • Phone: 717-840-4646
  • Fax: 717-840-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARVIN WILBERN INSCORE JR.
Title or Position: OWNER
Credential:
Phone: 717-840-4646