Provider Demographics
NPI:1720496557
Name:LOCK HAVEN MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:LOCK HAVEN MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BHARAT
Authorized Official - Middle Name:G
Authorized Official - Last Name:ADROJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-748-1550
Mailing Address - Street 1:930 BELLEFONTE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-2754
Mailing Address - Country:US
Mailing Address - Phone:570-748-1550
Mailing Address - Fax:570-748-1510
Practice Address - Street 1:930 BELLEFONTE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-2754
Practice Address - Country:US
Practice Address - Phone:570-748-1550
Practice Address - Fax:570-748-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056999363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty