Provider Demographics
NPI:1699925107
Name:DR HADLEYS HOUSECALL SERVICE PC
Entity type:Organization
Organization Name:DR HADLEYS HOUSECALL SERVICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:HADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-515-2797
Mailing Address - Street 1:301 UNION AVE # 396
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3249
Mailing Address - Country:US
Mailing Address - Phone:814-515-2797
Mailing Address - Fax:814-515-1445
Practice Address - Street 1:2703 FAIRWAY DR
Practice Address - Street 2:1C
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4442
Practice Address - Country:US
Practice Address - Phone:814-515-2797
Practice Address - Fax:814-515-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010199L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG80833Medicare UPIN