Basic Information
| Provider Information | |||||||||
| NPI: | 1548242001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZUCKERMAN | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | EVAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173374168 | ||||||||
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| Practice Location | |||||||||
| Address1: | 147 GETTYS ST | ||||||||
| Address2: | |||||||||
| City: | GETTYSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173252534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173374168 | ||||||||
| FaxNumber: | 7173374142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 08/08/2019 | ||||||||
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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 | 207L00000X | MD041460L | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0192512000 | 01 | PA | AMERIHEALTH 65 PA | OTHER | 027363 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 41572 | 01 | PA | GEISINGER | OTHER | 001214253 | 05 | PA | MEDICAID | 20046655 | 01 | PA | AMERIHEALTH MERCY | OTHER | P00236480 | 01 | PA | RAILROAD MEDICARE | OTHER | 1529734 | 01 | PA | GATEWAY | OTHER | 50067116 | 01 | PA | CAPITAL BLUE CROSS | OTHER |