Healthcare Provider Details

I. General information

NPI: 1891196630
Provider Name (Legal Business Name): EMILY REBECCA GUNDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY R DETTER

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 S GEORGE ST
YORK PA
17403-5009
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-4090
  • Fax: 717-741-3554
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA003381
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA057130
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA057130
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: