Provider Demographics
NPI:1750461406
Name:HANOVER SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:HANOVER SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-677-4258
Mailing Address - Street 1:400 YORK ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-3357
Mailing Address - Country:US
Mailing Address - Phone:717-637-8955
Mailing Address - Fax:717-637-6376
Practice Address - Street 1:400 YORK ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-3357
Practice Address - Country:US
Practice Address - Phone:717-637-8955
Practice Address - Fax:717-637-6376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016695E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006975490001Medicaid
PA98225OtherHIGHMARK BLUE SHIELD
PA02308000OtherCAPITAL BLUE CROSS
PA98225OtherHIGHMARK BLUE SHIELD
PA0006975490001Medicaid