Provider Demographics
NPI:1710951579
Name:TICE, JOSHUA GARDNER (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:GARDNER
Last Name:TICE
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 1:531 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-1906
Mailing Address - Country:US
Mailing Address - Phone:717-220-1379
Mailing Address - Fax:
Practice Address - Street 1:PENN STATE M.S. HERSHEY, MED CENTER, DEPT RAD., H066
Practice Address - Street 2:500 UNIVERSITY DR
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033
Practice Address - Country:US
Practice Address - Phone:717-531-8521
Practice Address - Fax:717-531-0922
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1916952085R0202X
VA0101235097208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice