Provider Demographics
NPI:1326151200
Name:ABBOTTSTOWN MEDICAL CENTER PC
Entity Type:Organization
Organization Name:ABBOTTSTOWN MEDICAL CENTER PC
Other - Org Name:HILLSIDE MEDICAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:AQUIL
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-637-2100
Mailing Address - Street 1:250 FAME AVENUE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331
Mailing Address - Country:US
Mailing Address - Phone:717-637-2100
Mailing Address - Fax:717-637-2301
Practice Address - Street 1:250 FAME AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331
Practice Address - Country:US
Practice Address - Phone:717-637-2100
Practice Address - Fax:717-637-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 052832 L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01564529Medicaid
PA836172Medicare ID - Type Unspecified
G 21770Medicare UPIN