Provider Demographics
NPI:1336119023
Name:MATERNAL FETAL MEDICINE OF CENTRAL PENNSYLVANIA, P.C.
Entity Type:Organization
Organization Name:MATERNAL FETAL MEDICINE OF CENTRAL PENNSYLVANIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CODER/BILLING ASSOCIATE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CALE
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:717-231-8534
Mailing Address - Street 1:100 SOUTH SECOND STREET SUITE 4B
Mailing Address - Street 2:MEDICAL SCIENCES BUILDING
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-2541
Mailing Address - Country:US
Mailing Address - Phone:717-231-8472
Mailing Address - Fax:717-231-8490
Practice Address - Street 1:100 SOUTH SECOND STREET SUITE 4B
Practice Address - Street 2:MEDICAL SCIENCES BUILDING
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2541
Practice Address - Country:US
Practice Address - Phone:717-231-8472
Practice Address - Fax:717-231-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A170300000X
PAOS004932L207VM0101X
PAOS007488L207VM0101X
PAOS013803207VM0101X
PAMD040659L2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No170300000XOther Service ProvidersGenetic Counselor, MSGroup - Multi-Specialty
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007388130006Medicaid
PA783985OtherBLUESHIELD OF PA GROUP ID
PAPSH047036Medicare ID - Type UnspecifiedGROUP PRACTICE ID