Provider Demographics
NPI:1104874114
Name:RUNG, LEROY KARL (PAC)
Entity type:Individual
Prefix:MR
First Name:LEROY
Middle Name:KARL
Last Name:RUNG
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:423 NORTH 21ST ST.
Practice Address - Street 2:STE. 300
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011
Practice Address - Country:US
Practice Address - Phone:717-763-2559
Practice Address - Fax:717-909-3889
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA001806L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50058941OtherCAPITAL BC
PA101491RQJMedicare PIN