Organization
CENTRAL PENNSYLVANIA PULMONARY ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY A CLARK MD (PRESIDENT CEO)
(717) 724-2791
Entity
Organization
Contact information
Practice address
2250 MILLENIUM WAY, STE 400, ENOLA, PA 17025-1488
(717) 724-2791
(717) 724-2797
Mailing address
2250 MILLENIUM WAY, SUITE 400, ENOLA, PA 17025-1488
(717) 724-2791
(717) 724-2797
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001957188 0002
—
PA
01
—
02753200
CAPITAL BLUE CROSS
—
01
—
1485178
HIGHMARK
—
01
—
1547028
GATEWAY
—
01
—
20042172
AMERIHEALTH MERCY
—
01
—
2176430000
PERSONAL CHOICE PPO
—
01
—
3841362
AETNA HMO
—
01
—
7578487
AETNA NON HMO
—
Enumeration date
05/02/2006
Last updated
11/07/2007
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