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General NPI Number Information
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NPI Number | 1346287489
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Entity Type | Organization
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Legal Business Name | PENNSYLVANIA TOXICOLOGISTS PC
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 111 S FRONT ST
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City | HARRISBURG
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State | PA
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Zip | 17101
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Country | US
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Telephone | 717-782-5185
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Fax | 717-782-5188
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Provider Business Mailing Address
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Address Line | PO BOX 517
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City | HAZLETON
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State | PA
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Zip | 18201-0517
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Country | US
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Telephone | 570-450-6200
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Fax | 570-450-6207
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH WARD DONOVAN
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Credential | MD
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Telephone | 717-782-5185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083T0002X
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Taxonomy Name | Medical Toxicology (Preventive Medicine) Physician
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License Number | MD036157L
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License Number State | PA
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