Provider Demographics
NPI:1962888370
Name:DOUGLAS AVERY & ASSOCIATES, LTD
Entity type:Organization
Organization Name:DOUGLAS AVERY & ASSOCIATES, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-972-1100
Mailing Address - Street 1:4714 GETTYSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4325
Mailing Address - Country:US
Mailing Address - Phone:717-972-1100
Mailing Address - Fax:
Practice Address - Street 1:8926 CHESAPEAKE AVE STE A
Practice Address - Street 2:
Practice Address - City:NORTH BEACH
Practice Address - State:MD
Practice Address - Zip Code:20714-4050
Practice Address - Country:US
Practice Address - Phone:410-289-3341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SELECT MEDICAL CORPORATIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-07
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPENDINGMedicaid