Registry details
Type
Individual
Primary specialty
Specialist
Enumerated
Jul 13, 2005
License(s)
MD123456E (PA), MD014933E (PA), MD014933E (PA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 845 NORMAN DR | Lebanon, PA 17042-7445 | 717-273-8091 |
| LOCATION | 845 NORMAN DR | Lebanon, PA 17042-7445 | 717-273-8091 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.