Basic Information
| Provider Information | |||||||||
| NPI: | 1528022951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORTNA | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | SUITE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178513712 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 S GEORGE ST | ||||||||
| Address2: | MKB 4TH FLR | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512417 | ||||||||
| FaxNumber: | 7178513712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 11/10/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | MD043028L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 00025768502 | 01 | NY | UNIVERA | OTHER | 0940183 | 05 | OH | MEDICAID | 1770316 | 01 | PA | AETNA | OTHER | 733398 | 01 | PA | BLUE SHIELD | OTHER | 001406477 | 05 | PA | MEDICAID | 1071715 | 01 | WV | WEST VIRGINIA WORKERS COMP | OTHER | 268092 | 01 | PA | UNISON-WMG | OTHER | 1039836 | 01 | PA | GATEWAY | OTHER | 949364 | 01 | MD | CAREFIRST MD BCBS | OTHER | 20089138 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 210777 | 01 | PA | UNISON | OTHER | 313005 | 01 | PA | UPMC | OTHER | P00440841 | 01 | PA | RR MEDICARE | OTHER |