Provider Demographics
NPI:1871750091
Name:HY J DEPAMPHILIS, M.D.
Entity type:Organization
Organization Name:HY J DEPAMPHILIS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEPAMPHILIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-633-6644
Mailing Address - Street 1:795 CHERRY TREE CT
Mailing Address - Street 2:STE 3
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-7900
Mailing Address - Country:US
Mailing Address - Phone:717-633-6644
Mailing Address - Fax:717-633-6044
Practice Address - Street 1:795 CHERRY TREE CT
Practice Address - Street 2:STE 3
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-7900
Practice Address - Country:US
Practice Address - Phone:717-633-6644
Practice Address - Fax:717-633-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029689E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009137970001Medicaid
PA129127Medicare PIN
PA0009137970001Medicaid