Provider Demographics
NPI:1619963303
Name:ORTHOPAEDIC SURGEONS OF CENTRAL PENNSYLVANIA LTD
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGEONS OF CENTRAL PENNSYLVANIA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:W
Authorized Official - Last Name:FULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-901-8000
Mailing Address - Street 1:99 NOVEMBER DR
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-5064
Mailing Address - Country:US
Mailing Address - Phone:717-901-8000
Mailing Address - Fax:717-761-6860
Practice Address - Street 1:99 NOVEMBER DR
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-5064
Practice Address - Country:US
Practice Address - Phone:717-901-8000
Practice Address - Fax:717-761-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001686352-0001Medicaid
PA2943Medicare ID - Type Unspecified