=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760770697
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY GRACE HAHN PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2011
-----------------------------------------------------
Last Update Date | 07/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3025 MARKET ST
-----------------------------------------------------
City | CAMP HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17011-4518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-691-1212
-----------------------------------------------------
Fax | 717-691-5354
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 785 5TH AVE STE 3
-----------------------------------------------------
City | CHAMBERSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17201-4232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-263-9555
-----------------------------------------------------
Fax | 717-709-6529
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | MA055472
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 030288
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------