| NPI | 1023069408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY L. MULL Director, Credentialing 570-271-6144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine |
| 2085R0202X Radiology Diagnostic Radiology | |
| 291U00000X Clinical Medical Laboratory | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2015-03-03 |