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General NPI Number Information
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NPI Number | 1861862591
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Entity Type | Organization
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Legal Business Name | INTERNISTS OF CENTRAL PENNSYLVANIA
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 10/07/2015
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Provider Practice Location Address
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Address Line | 108 LOWTHER ST
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City | LEMOYNE
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State | PA
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Zip | 17043-2045
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Country | US
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Telephone | 717-774-1366
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Fax |
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Provider Business Mailing Address
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Address Line | 154 ERFORD RD APT 405
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City | CAMP HILL
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State | PA
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Zip | 17011-1827
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Country | US
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Telephone | 740-504-3140
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | GEORGIA JOHNSON
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Credential |
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Telephone | 717-774-1366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA057852
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA057852
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License Number State | PA
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