Provider Demographics
NPI:1649809559
Name:HARK, JUSTIN DANIEL (DO)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DANIEL
Last Name:HARK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-1632
Mailing Address - Country:US
Mailing Address - Phone:610-322-6202
Mailing Address - Fax:
Practice Address - Street 1:400 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1167
Practice Address - Country:US
Practice Address - Phone:717-242-7180
Practice Address - Fax:717-242-7299
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS022827207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine