Provider Demographics
NPI:1023040490
Name:DAVENSHIRE MEDICAL CENTER PARTNERSHIP
Entity type:Organization
Organization Name:DAVENSHIRE MEDICAL CENTER PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-292-3168
Mailing Address - Street 1:3740 CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-4416
Mailing Address - Country:US
Mailing Address - Phone:717-292-3168
Mailing Address - Fax:717-292-3479
Practice Address - Street 1:3740 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315-4416
Practice Address - Country:US
Practice Address - Phone:717-292-3168
Practice Address - Fax:717-292-3479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA054377Medicare PIN