Provider Demographics
NPI:1780685537
Name:CONSEVAGE, MICHAEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:CONSEVAGE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 N FRONT ST
Practice Address - Street 2:PEDIATRIC CARDIOLOGY
Practice Address - City:WORMLEYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17043-1034
Practice Address - Country:US
Practice Address - Phone:717-761-0200
Practice Address - Fax:717-761-0641
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2018-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD042293L2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001471500Medicaid
PAF85782Medicare UPIN
PA001471500Medicaid