Provider Demographics
NPI:1083950687
Name:HANOVER HEALTH CORPORATION
Entity Type:Organization
Organization Name:HANOVER HEALTH CORPORATION
Other - Org Name:HANOVER MEDICAL GROUP EXPRESS CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-646-4120
Mailing Address - Street 1:310 STOCK ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2276
Mailing Address - Country:US
Mailing Address - Phone:717-633-8858
Mailing Address - Fax:717-316-2240
Practice Address - Street 1:1404 BALTIMORE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-8698
Practice Address - Country:US
Practice Address - Phone:717-637-0470
Practice Address - Fax:717-637-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty