Provider Demographics
NPI:1952358186
Name:UROLOGICAL CENTER P A
Entity type:Organization
Organization Name:UROLOGICAL CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:KLAUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:301-733-0022
Mailing Address - Street 1:PO BOX 37813
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-7813
Mailing Address - Country:US
Mailing Address - Phone:301-733-0022
Mailing Address - Fax:301-733-3461
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 228
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6727
Practice Address - Country:US
Practice Address - Phone:301-733-0022
Practice Address - Fax:301-733-3461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH530Medicare PIN
PA113214Medicare PIN