Provider Demographics
NPI:1538272646
Name:WAYNESBORO MEDICAL ASSOCIATES,LLC
Entity type:Organization
Organization Name:WAYNESBORO MEDICAL ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENHANZEB
Authorized Official - Middle Name:
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-749-0150
Mailing Address - Street 1:12104 BUCHANAN TRAIL EAST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268
Mailing Address - Country:US
Mailing Address - Phone:717-749-0150
Mailing Address - Fax:717-749-0153
Practice Address - Street 1:12104 BUCHANAN TRAIL EAST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268
Practice Address - Country:US
Practice Address - Phone:717-749-0150
Practice Address - Fax:717-749-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059027-L261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001909654000Medicaid
PAG40562Medicare UPIN
PA001909654000Medicaid