MEDICARE: CUMBERLAND VALLEY ENDOCRINOLOGY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001385966	OTHER	PA	KEYSTONE HEALTH PLAN
2	0001385966	OTHER	PA	BLUE CROSS/ BLUE SHIELD
3	50000722	OTHER	PA	CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1194721860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUMBERLAND VALLEY ENDOCRINOLOGY CENTER, LLC

Provider Business Mailing Address
First Line	:	49 BROOKWOOD AVE
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-9126
Country	:	US
Telephone Number	:	717-258-1462
Fax Number	:	717-258-8164

Provider Business Practice Location Address
First Line	:	49 BROOKWOOD AVE
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-9126
Country	:	US
Telephone Number	:	717-258-1462
Fax Number	:	717-258-8164

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW J. BEHNKE
Credential	:	M.D.
Telephone Number	:	717-258-1462

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	08/22/2020

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