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General NPI Number Information
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NPI Number | 1457824013
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Entity Type | Organization
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Legal Business Name | PENN STATE HEALTH MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 4520 UNION DEPOSIT RD
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City | HARRISBURG
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State | PA
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Zip | 17111-2910
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Country | US
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Telephone | 717-531-4094
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Fax | 717-531-0136
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Provider Business Mailing Address
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Address Line | PO BOX 825972
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City | PHILADELPHIA
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State | PA
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Zip | 19182-5972
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Country | US
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Telephone | 717-531-4859
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Fax | 717-312-3104
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Authorized Official
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Title or Position | EX. VICE PRES, CHIEF FINANCIAL OFC
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Name | TRACY L MOYER-SWINKO
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Credential |
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Telephone | 717-531-8477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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