Individual
SUMANA NAGAVALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
899 POPLAR CHURCH RD, CAMP HILL, PA 17011-2206
(717) 763-3043
Mailing address
899 POPLAR CHURCH RD, CAMP HILL, PA 17011-2206
(717) 763-0430
(717) 763-9854
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA060233
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027526380001
—
PA
01
—
MA060233
STATE LICENSE
PA
Enumeration date
12/17/2012
Last updated
10/19/2021
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