1679903611 NPI number — ELIZABETH MARY SMITH PA-C

Table of content: DR. CAROL NICOLE GORMAN MD (NPI 1316037450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679903611 NPI number — ELIZABETH MARY SMITH PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
ELIZABETH
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RITCHEY
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679903611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 BEECH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERSHEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17033-1507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-533-8079
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3912 TRINDLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMP HILL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17011-4246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-761-8740
Provider Business Practice Location Address Fax Number:
717-761-8792
Provider Enumeration Date:
11/12/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  MA056556 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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