Provider Demographics
NPI:1558394908
Name:OTOLARYNGOLOGY GROUP OF CENTRAL PENNSYLVANIA
Entity Type:Organization
Organization Name:OTOLARYNGOLOGY GROUP OF CENTRAL PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YI
Authorized Official - Middle Name:H
Authorized Official - Last Name:KAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-339-7101
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-0592
Mailing Address - Country:US
Mailing Address - Phone:814-339-7101
Mailing Address - Fax:814-339-6165
Practice Address - Street 1:2505 GREEN TECH DR
Practice Address - Street 2:SUITE C
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2316
Practice Address - Country:US
Practice Address - Phone:814-231-7750
Practice Address - Fax:814-371-7752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017302900002Medicaid
PA022276Medicare PIN