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Organization

NITTANY VALLEY MEDICAL ASSOCIATES P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
EILEEN CLARKE (PRACTICE MANAGER)
(814) 359-6866
Entity
Organization

Contact information

Practice address
2134 SANDY DR STE 16, STATE COLLEGE, PA 16803-2292
(814) 272-5805
(814) 272-0110
Mailing address
2134 SANDY DR STE 16, STATE COLLEGE, PA 16803-2292
(814) 272-5805
(814) 272-0110

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0019162000001
PA
01
104H
GEISINGER
PA
01
1409586
HIGHMARK BS
PA
01
50000799
CAPITAL BC/BS
PA
01
CJ9571
RAILROAD MEDICARE
PA
Enumeration date
10/03/2005
Last updated
10/28/2021
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