Individual
SI V DO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
40 MATTHEW DR, NEW OXFORD, PA 17350-9195
(717) 856-3095
Mailing address
40 MATTHEW DR, NEW OXFORD, PA 17350-9195
(717) 856-3095
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD047241L
PA
Other
Enumeration date
08/07/2008
Last updated
08/07/2008
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