Provider Demographics
NPI:1346996782
Name:PENN STATE HEALH COMMUNITY MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:PENN STATE HEALH COMMUNITY MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-531-4859
Mailing Address - Street 1:PO BOX 825972
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5972
Mailing Address - Country:US
Mailing Address - Phone:717-531-4859
Mailing Address - Fax:717-312-3104
Practice Address - Street 1:810 PLAZA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2762
Practice Address - Country:US
Practice Address - Phone:717-431-2368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty