Provider Demographics
NPI:1346287489
Name:PENNSYLVANIA TOXICOLOGISTS PC
Entity Type:Organization
Organization Name:PENNSYLVANIA TOXICOLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-782-5185
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-0517
Mailing Address - Country:US
Mailing Address - Phone:570-450-6200
Mailing Address - Fax:570-450-6207
Practice Address - Street 1:111 S FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101
Practice Address - Country:US
Practice Address - Phone:717-782-5185
Practice Address - Fax:717-782-5188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036157L2083T0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical ToxicologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006642430005Medicaid
PA1019058810001Medicaid
PA1016451290001Medicaid
PA1016451290001Medicaid
PA0006642430005Medicaid
PA1019058810001Medicaid
PA095515V65Medicare PIN
PA101660V65Medicare PIN