Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD473624 | PA |
NPI | 1003307067 |
---|---|
Provider Name | Dr. Michael Timothy Partin |
First Address | Hershey, PA 17033-0858 |
Second Address | Harrisburg, PA 17112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2018 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1037055490001 | (05) | PA |