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General NPI Number Information
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NPI Number | 1720548142
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Entity Type | Individual
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Provider Name | MIKAEL HORISSIAN
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Gender | Male
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | GEISINGER MEDICAL CENTER 16 WOODBINE LANE
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City | DANVILLE
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State | PA
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Zip | 17822-2360
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Country | US
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Telephone | 570-271-8050
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Fax | 570-271-5940
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Provider Business Mailing Address
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Address Line | 500 UNIVERSITY DR
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City | HERSHEY
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State | PA
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Zip | 17033-2360
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Country | US
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Telephone | 276-698-0785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD480408
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License Number State | PA
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