Provider Demographics
NPI:1033114301
Name:HANOVER ORTHOPAEDIC ASSOCIATES,INC
Entity Type:Organization
Organization Name:HANOVER ORTHOPAEDIC ASSOCIATES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-632-5259
Mailing Address - Street 1:207 BLOOMING GROVE RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-7917
Mailing Address - Country:US
Mailing Address - Phone:717-632-5259
Mailing Address - Fax:717-632-2422
Practice Address - Street 1:207 BLOOMING GROVE RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-7917
Practice Address - Country:US
Practice Address - Phone:717-632-5259
Practice Address - Fax:717-632-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA43590207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006797100002Medicaid
200027737OtherRAILROAD MEDICARE
02458600OtherCAPITAL BLUE CROSS
43590OtherBCBS
1248700001Medicare NSC
02458600OtherCAPITAL BLUE CROSS