Provider Demographics
NPI:1578218152
Name:PENN STATE HEALTH COMMUNITY MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:PENN STATE HEALTH COMMUNITY MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-208-8818
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0848
Mailing Address - Country:US
Mailing Address - Phone:610-208-8818
Mailing Address - Fax:717-312-3104
Practice Address - Street 1:2494 BERNVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9468
Practice Address - Country:US
Practice Address - Phone:610-378-2225
Practice Address - Fax:610-208-8839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-13
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty