Basic Information
| Provider Information | |||||||||
| NPI: | 1003973082 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HURTT | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | DERRICK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516969 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 S GEORGE ST | ||||||||
| Address2: | DEPARTMENT OF PATHOLOGY | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174057198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178515001 | ||||||||
| FaxNumber: | 7178515114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 05/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | MD430814 | PA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 109291 | 01 | PA | GEISINGER HEALTH PLAN YH | OTHER | 212178 | 01 | PA | UNISON-YH | OTHER | 7412949 | 01 | PA | AETNA-YH | OTHER | 30156216 | 01 | PA | AMERIHEALTH CARITAS - GH | OTHER | 1958779 | 01 | PA | HIGHMARK BLUE SHIELD-YH | OTHER | 101886329 | 05 | PA | MEDICAID | 20061846 | 01 | PA | AMERIHEALTH MERCY-YH | OTHER | 1567921 | 01 | PA | GATEWAY-WMG | OTHER | 30124654 | 01 | PA | AMERIHEALTH MERCY - WSRH | OTHER | 50068350 | 01 | PA | CAPITAL BLUE CROSS-YH | OTHER | 207625 | 01 | PA | JOHNS HOPKINS-YH | OTHER |