Provider Demographics
NPI:1609949585
Name:EPHRATA FAMILY PRACTICE ASSOCIATES
Entity Type:Organization
Organization Name:EPHRATA FAMILY PRACTICE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:CAMERINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-738-2468
Mailing Address - Street 1:44 LANCASTER AVE.
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1708
Mailing Address - Country:US
Mailing Address - Phone:717-738-2468
Mailing Address - Fax:717-738-9936
Practice Address - Street 1:44 LANCASTER AVE.
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1708
Practice Address - Country:US
Practice Address - Phone:717-738-2468
Practice Address - Fax:717-738-9936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041289E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty