Provider Demographics
NPI:1164437612
Name:HANOVER ANESTHESIOLOGY AND PAIN MEDICINE, P.C.
Entity Type:Organization
Organization Name:HANOVER ANESTHESIOLOGY AND PAIN MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MUMMERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-632-9955
Mailing Address - Street 1:250 FAME AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1587
Mailing Address - Country:US
Mailing Address - Phone:717-632-9955
Mailing Address - Fax:717-632-9893
Practice Address - Street 1:250 FAME AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-632-9955
Practice Address - Fax:717-632-9893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherEIN