Provider Demographics
NPI:1346268489
Name:MCCULLOUGH, ALICE QUINTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:QUINTIN
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:ANN
Other - Last Name:QUINTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2297
Mailing Address - Country:US
Mailing Address - Phone:717-316-3711
Mailing Address - Fax:
Practice Address - Street 1:300 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2297
Practice Address - Country:US
Practice Address - Phone:717-316-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425215208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20090438OtherAMERIHEALTH MERCY-WMG
PA2161248OtherMAMSI-WMG BIMH
PA50055999OtherCAPITAL BC-WMG GB HOSP
PA175371OtherUNISON-WMG GB HOSPITALIST
PA100459OtherGEISINGER
PA1101227808Medicaid
PA1696446OtherHIGHMARK BLUE SHIELD
MD007846800Medicaid
MD645230OtherCAREFIRST MD BCBS
PA7359856OtherAETNA
PA1542178OtherGATEWAY-WMG
PA50046321OtherCAPITAL BC-WMG BROCK HOSP
PA109373OtherJOHNS HOPKINS
PA167120OtherUNISON-WMG BROCKIE HOSP
PA2161249OtherMAMSI-WMG GB HOSPITALISTS
PA2368348000OtherAMERIHEALTH 65 PA
PAP00261851Medicare PIN
PA50046321OtherCAPITAL BC-WMG BROCK HOSP
PA1696446OtherHIGHMARK BLUE SHIELD