MEDICARE: DR. IRA SACKMAN M.D.

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	207R00000X	Internal Medicine Physician	MD019573E	PA
2	207RC0000X	Cardiovascular Disease Physician	MD019573E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	060037222	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316940455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRA SACKMAN M.D.

Provider Business Mailing Address
First Line	:	409 S 2ND ST
Second Line	:	SUITE 2F
City	:	HARRISBURG
State	:	PA
Zip	:	17104-1612
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2808 OLD POST RD
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-3670
Country	:	US
Telephone Number	:	717-920-4400
Fax Number	:	717-920-4553

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/15/2017

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