Organization
CENTRE PROFESSIONAL ASSOCIATES LLC
Active
Organization
CENTRE PROFESSIONAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY DERSTINE MD (OWNER)
(814) 689-9744
Entity
Organization
Contact information
Practice address
315 S ALLEN ST, STE 216, STATE COLLEGE, PA 16801-4849
(814) 689-9744
(888) 981-8069
Mailing address
PO BOX 1120, LEMONT, PA 16851-1120
(814) 689-9744
(888) 981-8069
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
MD056013L
PA
2084P0800X
Psychiatry Physician
Primary
MD056013L
PA
Other
Enumeration date
06/24/2016
Last updated
06/24/2016
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