=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538790282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MILTON S HERSHEY MEDICAL CENTER - PHYSICIANS GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2020
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1150 COCOA AVE
-----------------------------------------------------
City | HERSHEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17033-1712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-531-6015
-----------------------------------------------------
Fax | 717-531-0140
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 UNIVERSITY DRIVE MAILCODE CA410
-----------------------------------------------------
City | HERSHEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17033-2360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-531-1159
-----------------------------------------------------
Fax | 717-531-0119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DONALD MCKENNA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-531-3979
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------