Provider Demographics
NPI:1194727180
Name:GETTYSBURG FAMILY PRACTICE INC
Entity type:Organization
Organization Name:GETTYSBURG FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-334-2183
Mailing Address - Street 1:524 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-2594
Mailing Address - Country:US
Mailing Address - Phone:717-334-2183
Mailing Address - Fax:717-334-5246
Practice Address - Street 1:524 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2594
Practice Address - Country:US
Practice Address - Phone:717-334-2183
Practice Address - Fax:717-334-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA655681Medicare ID - Type Unspecified
X19819Medicare UPIN