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General NPI Number Information
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NPI Number | 1689119794
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Entity Type | Organization
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Legal Business Name | DIAKON MEDICAL GROUP LLC
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 280 MIDDLE HOLLAND RD
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City | HOLLAND
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State | PA
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Zip | 18966-4822
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Country | US
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Telephone | 717-795-0457
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Fax | 717-796-6801
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Provider Business Mailing Address
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Address Line | 1022 N UNION ST
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City | MIDDLETOWN
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State | PA
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Zip | 17057-2158
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Country | US
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Telephone | 717-795-0384
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Fax | 717-795-0353
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Authorized Official
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Title or Position | EVP/COO/CFO
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Name | MR. SCOTT D HABECKER
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Credential |
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Telephone | 717-795-0384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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