Basic Information
| Provider Information | |||||||||
| NPI: | 1699325407 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE MILTON S HERSHEY MEDICAL CENTER PHYSICIAN GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 858 MC A410 | ||||||||
| Address2: | |||||||||
| City: | HERSHEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170330858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002431455 | ||||||||
| FaxNumber: | 7175315596 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 UNIVERSITY DRIVE | ||||||||
| Address2: | |||||||||
| City: | HERSHEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170330858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175318044 | ||||||||
| FaxNumber: | 7175315596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2019 | ||||||||
| LastUpdateDate: | 09/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | ROMANOSKI | ||||||||
| AuthorizedOfficialFirstName: | KATHRYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER ENROLLMENT SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 7175311061 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.