Provider Demographics
NPI:1043277338
Name:TRISTAN ASSOCIATES
Entity type:Organization
Organization Name:TRISTAN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO TRISTAN ASSOCIATES
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELOIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:717-652-6105
Mailing Address - Street 1:4520 UNION DEPOSIT RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111
Mailing Address - Country:US
Mailing Address - Phone:717-652-6105
Mailing Address - Fax:717-652-2165
Practice Address - Street 1:120 HAMM DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837
Practice Address - Country:US
Practice Address - Phone:570-522-9300
Practice Address - Fax:570-522-9304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACA9270OtherRAILROAD MEDICARE
PA0006719450013Medicaid
PACA9270OtherRAILROAD MEDICARE