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NPI Code Detail

MEDICARE: ROBERT D GINGRICH MPSSC COBT CAS

MEDICARE: ROBERT D GINGRICH MPSSC COBT CAS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1194725572
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT D GINGRICH MPSSC COBT CAS
Provider Business Mailing Address
First Line : 632 CUMBERLAND ST
Second Line :
City : LEBANON
State : PA
Zip : 17042-5230
Country : US
Telephone Number : 717-273-1710
Fax Number : 717-273-1416
Provider Business Practice Location Address
First Line : 40 PEARL ST
Second Line :
City : LANCASTER
State : PA
Zip : 17603-3231
Country : US
Telephone Number : 717-397-8081
Fax Number : 717-397-8414
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2005
Last Update Date : 07/08/2007

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