Organization
LUNG SLEEP AND CRITICAL CARE CONSULTANTS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
T GLEN BOUDER MD (DIRECTOR/ACTIVE,ATTENDING)
(747) 851-6151
Entity
Organization
Contact information
Practice address
2350 FREEDOM WAY, SUITE 200, YORK, PA 17402-8200
(717) 851-2465
(717) 741-3043
Mailing address
2350 FREEDOM WAY, SUITE 200, YORK, PA 17402-8200
(717) 851-2465
(717) 741-3043
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
MD051542L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1014367640001
25 MONUMENT RD #/DEACTIVATED AS OF 10/2008
PA
05
—
1014367640005
—
PA
Enumeration date
08/23/2005
Last updated
04/20/2009
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