Provider Demographics
NPI:1548242001
Name:ZUCKERMAN, MITCHELL EVAN (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:EVAN
Last Name:ZUCKERMAN
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:717-337-4168
Mailing Address - Fax:
Practice Address - Street 1:147 GETTYS ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2534
Practice Address - Country:US
Practice Address - Phone:717-337-4168
Practice Address - Fax:717-337-4142
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041460L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0192512000OtherAMERIHEALTH 65 PA
PA027363OtherHIGHMARK BLUE SHIELD
PA41572OtherGEISINGER
PA001214253Medicaid
PA20046655OtherAMERIHEALTH MERCY
PAP00236480OtherRAILROAD MEDICARE
PA1529734OtherGATEWAY
PA50067116OtherCAPITAL BLUE CROSS
B58558Medicare UPIN