Provider Demographics
NPI:1689870313
Name:PINCHOT FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:PINCHOT FAMILY MEDICINE, P.C.
Other - Org Name:PINCHOT FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-571-9942
Mailing Address - Street 1:7475 CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17365-9627
Mailing Address - Country:US
Mailing Address - Phone:717-502-4149
Mailing Address - Fax:
Practice Address - Street 1:7475 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17365-9627
Practice Address - Country:US
Practice Address - Phone:717-502-4149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073665L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
112761OtherMEDICARE GROUP NUMBER