Provider Demographics
NPI:1972569911
Name:ARMSTRONG, JACK L (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:L
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 BENT CREEK BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1870
Mailing Address - Country:US
Mailing Address - Phone:717-791-2640
Mailing Address - Fax:717-791-2646
Practice Address - Street 1:1700 BENT CREEK BLVD STE 210
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1870
Practice Address - Country:US
Practice Address - Phone:717-243-7540
Practice Address - Fax:717-243-9968
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069595L207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001766560Medicaid
PA1520984OtherGATEWAY IND
PA696513OtherHIGHMARK BLUE SHIELD IND
PA02047901OtherCAPITAL BLUE CROSS IND
PA1520984OtherGATEWAY IND
PAF68927Medicare UPIN