Provider Demographics
NPI:1609879691
Name:DEPAMPHILIS, HY J (MD)
Entity Type:Individual
Prefix:
First Name:HY
Middle Name:J
Last Name:DEPAMPHILIS
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 1:1800 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6709
Mailing Address - Country:US
Mailing Address - Phone:814-231-7000
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:800-243-1455
Practice Address - Fax:717-531-7269
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029689E207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0913797Medicaid
PA238424OtherMAMSI
PA8120073OtherCIGNA
PA991630OtherKEYSTONE HEALTH
PA521518160OtherYORK HEALTH
MD2683OtherMARYLAND BLUE SHIELD
PA8120073OtherCIGNA
PA991630OtherKEYSTONE HEALTH