Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2015-00478 | NC |
N | 207X00000X | Orthopaedic Surgeon | MT196612 | PA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD447323 | PA |
NPI | 1518287010 |
---|---|
Provider Name | Gary F Updegrove |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2010 |
Last Update Date | 16/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1032342850002 | (05) | PA |
1518287010 | (05) | NC |
NC2429 | (05) | SC |