Provider Demographics
NPI:1952311144
Name:HAMPDEN PHYSICIAN ASSOCIATES, LLC
Entity Type:Organization
Organization Name:HAMPDEN PHYSICIAN ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-635-2073
Mailing Address - Street 1:3456 TRINDLE RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4468
Mailing Address - Country:US
Mailing Address - Phone:717-635-2073
Mailing Address - Fax:717-635-2074
Practice Address - Street 1:3456 TRINDLE RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4468
Practice Address - Country:US
Practice Address - Phone:717-635-2073
Practice Address - Fax:717-635-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017093890001Medicaid
PA104913Medicare ID - Type UnspecifiedGROUP MEDICARE NO.