Provider Demographics
NPI:1659337210
Name:INTERNISTS OF CENTRAL PENNSYLVANIA LTD.
Entity Type:Organization
Organization Name:INTERNISTS OF CENTRAL PENNSYLVANIA LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:TYNDALL MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-774-1366
Mailing Address - Street 1:108 LOWTHER ST
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-2045
Mailing Address - Country:US
Mailing Address - Phone:717-774-1366
Mailing Address - Fax:717-774-4232
Practice Address - Street 1:108 LOWTHER ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-2045
Practice Address - Country:US
Practice Address - Phone:717-774-1366
Practice Address - Fax:717-774-4232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010307750020Medicaid
PA0010307750020Medicaid