Organization
LOCK HAVEN MEDICAL PROFESSIONALS PC
Active
Other names
Haven Orthopedic and Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
GARY NEWSOME (SENIOR VICE PRESIDENT)
(570) 893-5330
Entity
Organization
Contact information
Practice address
24 CREE DR, LOCK HAVEN, PA 17745-2639
(570) 893-5330
Mailing address
330 FRANKLIN ROAD,, #135A-501, BRENTWOOD, TN 37027
(615) 309-3300
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013815860001
—
PA
Enumeration date
03/21/2006
Last updated
08/22/2020
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