Basic Information
Provider Information
NPI: 1407587884
EntityType: 2
ReplacementNPI:  
OrganizationName: THE MILTON S HERSHEY MEDICAL CENTER PHYSICIANS GROUP
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 500 UNIVERSITY DRIVE
Address2: MC CA410
City: HERSHEY
State: PA
PostalCode: 170332036
CountryCode: US
TelephoneNumber: 7175311159
FaxNumber: 7175310119
Practice Location
Address1: 476 ROLLING RIDGE DR STE 101
Address2:  
City: STATE COLLEGE
State: PA
PostalCode: 168017639
CountryCode: US
TelephoneNumber: 8146894980
FaxNumber: 8146894990
Other Information
ProviderEnumerationDate: 06/17/2022
LastUpdateDate: 06/17/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: MASSINI
AuthorizedOfficialFirstName: STEPHEN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CHIEF EXECUTIVE OFFICER
AuthorizedOfficialTelephone: 7175316614
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/03/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


Home