Provider Demographics
NPI:1952358483
Name:ALTOONA ENDOCRINE SERVICES, L.L.C
Entity Type:Organization
Organization Name:ALTOONA ENDOCRINE SERVICES, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-949-2950
Mailing Address - Street 1:615 HOWARD AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4813
Mailing Address - Country:US
Mailing Address - Phone:814-949-2950
Mailing Address - Fax:814-949-2960
Practice Address - Street 1:615 HOWARD AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4813
Practice Address - Country:US
Practice Address - Phone:814-949-2950
Practice Address - Fax:814-949-2960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419670207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV0579BOtherUPMC GROUP PIN NUMBER
PA1011489000001Medicaid
PA1539532OtherGATEWAY HEALTHPLAN GROUP#
PADC 8045Medicare ID - Type UnspecifiedRAIL ROAD MEDICARE GROUP#
PA084154Medicare PIN