1043464506 NPI number — HERITAGE MEDICAL GROUP, LLP

Table of content: (NPI 1043464506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043464506 NPI number — HERITAGE MEDICAL GROUP, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERITAGE MEDICAL GROUP, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CUMBERLAND EAR, NOSE & THROAT/FACIAL PLASTIC SURGERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043464506
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 WALNUT ST
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
LEMOYNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17043-1168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-761-0208
Provider Business Mailing Address Fax Number:
717-761-2023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 TECHNOLOGY PKWY
Provider Second Line Business Practice Location Address:
SUITE G-03
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17050-9400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-728-9700
Provider Business Practice Location Address Fax Number:
717-728-9800
Provider Enumeration Date:
11/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CINCOTTA
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
717-761-0208

Provider Taxonomy Codes

  • Taxonomy code: 207YX0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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