Provider Demographics
NPI:1851338024
Name:ALLERGY AND ASTHMA CENTER PC
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA CENTER PC
Other - Org Name:ALLERGY IMMUNOLOGY ASSOCIATES LTD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:TITI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-393-1365
Mailing Address - Street 1:2445 MARIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1942
Mailing Address - Country:US
Mailing Address - Phone:717-393-1365
Mailing Address - Fax:717-393-8540
Practice Address - Street 1:2445 MARIETTA AVE
Practice Address - Street 2:ALLERGY & ASTHMA CENTER
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1942
Practice Address - Country:US
Practice Address - Phone:717-393-1365
Practice Address - Fax:717-393-8540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001166684Medicaid
0038794000OtherAMERIHEALTH
02470900OtherCAPITAL BLUECROSS
0185965OtherHIGHMARK BLUESHIELD
61743OtherAETNA
0038794000OtherKEYSTONE HEALTH PLAN EAST
02470900OtherKEYSTONE HEALTH PLAN CTRL
1519640OtherGATEWAY
30108OtherAMERIHEALTH MERCY
117194OtherUNISON
248732OtherMAMSI
3650OtherGEISINGER HEALTH PLAN
PA0185965Medicare ID - Type Unspecified