Provider Demographics
NPI:1336167113
Name:OBSTETRIC & GYNECOLOGIC ASSOCIATES OF HANOVER, INC.
Entity Type:Organization
Organization Name:OBSTETRIC & GYNECOLOGIC ASSOCIATES OF HANOVER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-632-1477
Mailing Address - Street 1:120 PENN ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1928
Mailing Address - Country:US
Mailing Address - Phone:717-632-1477
Mailing Address - Fax:717-632-8253
Practice Address - Street 1:120 PENN ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1928
Practice Address - Country:US
Practice Address - Phone:717-632-1477
Practice Address - Fax:717-632-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019036E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007257230001Medicaid
PA0007257230001Medicaid