Provider Demographics
NPI:1780654814
Name:MEDICAL HEALTH GROUP PA
Entity Type:Organization
Organization Name:MEDICAL HEALTH GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOLCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-369-1700
Mailing Address - Street 1:1415 S MOUNTAIN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3236
Mailing Address - Country:US
Mailing Address - Phone:410-369-1699
Mailing Address - Fax:410-369-1707
Practice Address - Street 1:1415 S MOUNTAIN RD STE 100
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3236
Practice Address - Country:US
Practice Address - Phone:410-369-1699
Practice Address - Fax:410-369-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W647OtherBLUE CHOICE
2977766006OtherCIGNA
0291801OtherUNITED HEALTH CARE
=========OtherHEALTHNET
=========OtherHELIX
2977766006OtherCIGNA
2977766006OtherCIGNA