MEDICARE: PENN STATE HEALTH MEDICAL GROUP, 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	207Q00000X	Family Medicine Physician
2	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1528714995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENN STATE HEALTH MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 825972
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-5972
Country	:	US
Telephone Number	:	717-531-4859
Fax Number	:	717-312-3104

Provider Business Practice Location Address
First Line	:	1211 FORGE RD STE 500
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-3186
Country	:	US
Telephone Number	:	717-218-3990
Fax Number	:	717-218-3991

Authorized Official
Title or Position	:	VP-CHIEF FINANCIAL OFFICER
Name	:	TRACY L MOYER-SWINKO
Credential	:
Telephone Number	:	717-531-8477

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	02/04/2026

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