Provider Demographics
NPI:1467511576
Name:WAYNESBORO FAMILY MEDICAL ASSOCIATES, LLP
Entity Type:Organization
Organization Name:WAYNESBORO FAMILY MEDICAL ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-762-9118
Mailing Address - Street 1:1051 E MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-2381
Mailing Address - Country:US
Mailing Address - Phone:717-762-9118
Mailing Address - Fax:717-762-2860
Practice Address - Street 1:14961 BUCHANAN TRAIL EAST
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:17214
Practice Address - Country:US
Practice Address - Phone:717-762-9118
Practice Address - Fax:717-762-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007427810002Medicaid
PA1007427810002Medicaid