Provider Demographics
NPI:1649357278
Name:YORKTOWNE UROLOGY, PC
Entity type:Organization
Organization Name:YORKTOWNE UROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROGGENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-741-9536
Mailing Address - Street 1:2350 FREEDOM WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402
Mailing Address - Country:US
Mailing Address - Phone:717-741-9536
Mailing Address - Fax:717-741-5509
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402
Practice Address - Country:US
Practice Address - Phone:717-741-9536
Practice Address - Fax:717-741-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02502300OtherCAPITAL BLUECROSS GROUP
PA1007713350010Medicaid
PA664700OtherHIGHMARK BLUESHIELD GROUP
PA02502300OtherCAPITAL BLUECROSS GROUP