=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376592170
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CPTA, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2006
-----------------------------------------------------
Last Update Date | 10/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 S FRONT ST BRADY 7
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17104-1619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-231-8864
-----------------------------------------------------
Fax | 717-231-8857
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 S FRONT ST BRADY 7
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17104-1619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-231-8804
-----------------------------------------------------
Fax | 717-231-8443
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | HAROLD C YANG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 717-231-8804
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 029717
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------