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NPI Code Detail

MEDICARE: DR. ENOCH GRAHAM SHISSLER MD

MEDICARE: DR. ENOCH GRAHAM SHISSLER MD
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
1390200000XStudent in an Organized Health Care Education/Training ProgramTL.0009294CO
2207Q00000XFamily Medicine PhysicianMD490737PA

General Provider Information

NPI Number : 1952042509
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ENOCH GRAHAM SHISSLER MD
Provider Business Mailing Address
First Line : 601 MEMORY LN
Second Line :
City : YORK
State : PA
Zip : 17402-2231
Country : US
Telephone Number : 717-851-1405
Fax Number : 717-851-6969
Provider Business Practice Location Address
First Line : 8131 SPYGLASS HILL DR
Second Line :
City : FAYETTEVILLE
State : PA
Zip : 17222-5500
Country : US
Telephone Number : 717-749-3181
Fax Number : 717-749-3191
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2022
Last Update Date : 05/06/2026

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