=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881699916
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD DUNHAM DEVELIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2005
-----------------------------------------------------
Last Update Date | 12/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1790 OLD TRAIL RD
-----------------------------------------------------
City | ETTERS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17319-9652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-938-6588
-----------------------------------------------------
Fax | 717-938-9601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 MEMORY LN
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17402-2231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-851-1405
-----------------------------------------------------
Fax | 717-851-6969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD045320E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------