Provider Demographics
NPI:1528178522
Name:DEGENHARD, JOSEPH G (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:G
Last Name:DEGENHARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-733-9090
Mailing Address - Fax:717-733-8982
Practice Address - Street 1:808 PLEASANTVIEW DR
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1644
Practice Address - Country:US
Practice Address - Phone:717-733-9090
Practice Address - Fax:717-733-8982
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAK000208171100000X
PAMD417766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018902940006Medicaid
PWP004493OtherGATEWAY
PA528636OtherAETNA
PA50051252OtherCAPITAL BLUE CROSS
PW1746358OtherBLUE SHIELD
PAH57350Medicare UPIN
PA0018902940006Medicaid