Provider Demographics
NPI:1740287655
Name:HENDRICKSON, DONALD CHARLES (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:CHARLES
Last Name:HENDRICKSON
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 1:755 NORLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4221
Mailing Address - Country:US
Mailing Address - Phone:717-263-2230
Mailing Address - Fax:717-263-4182
Practice Address - Street 1:176 S COLDBROOK AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2714
Practice Address - Country:US
Practice Address - Phone:717-263-0550
Practice Address - Fax:717-263-8898
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017657E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000646951Medicaid
B35085Medicare UPIN
PA000646951Medicaid