=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609963107
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA MARIE GONYA-HARTMAN AU.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 806 W MAIN ST
-----------------------------------------------------
City | MOUNT JOY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17552-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-653-6300
-----------------------------------------------------
Fax | 717-653-5595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 806 W MAIN ST PO BOX 375
-----------------------------------------------------
City | MOUNT JOY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17552-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-653-6300
-----------------------------------------------------
Fax | 717-653-5595
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AT-000569L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------