Provider Demographics
NPI:1922046036
Name:HERMANSEN, CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:HERMANSEN
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 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:540 N DUKE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2374
Practice Address - Country:US
Practice Address - Phone:717-544-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013372560003Medicaid
PA106587OtherGEISINGER HEALTH PLAN
PA000000257179OtherUNISON
PA2676007000OtherINDEPENDENCE BLUE CROSS
PA50082741OtherCAPITAL BLUE CROSS
PAP006720OtherGATEWAY
PA001821158OtherHIGHMARK BLUE SHIELD
PA265411OtherHEALTHAMERICA
PA20045108OtherAMERIHEALTH MERCY
PA7044550OtherAETNA
PA095074Medicare ID - Type Unspecified