Provider Demographics
NPI:1003837808
Name:CENTRAL PENNSYLVANIA UROLOGY PC
Entity Type:Organization
Organization Name:CENTRAL PENNSYLVANIA UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-843-2620
Mailing Address - Street 1:1408 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-1907
Mailing Address - Country:US
Mailing Address - Phone:717-843-2620
Mailing Address - Fax:717-854-7578
Practice Address - Street 1:1408 3RD AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-1907
Practice Address - Country:US
Practice Address - Phone:717-843-2620
Practice Address - Fax:717-854-7578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004533L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0866472Medicaid
PA109144Medicare ID - Type Unspecified
PA0866472Medicaid