Provider Demographics
NPI:1174698443
Name:HYATT P DEGREEN GAMMA LABORATORY
Entity type:Organization
Organization Name:HYATT P DEGREEN GAMMA LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HYATT
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:DEGREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-291-1313
Mailing Address - Street 1:1858 CHARTER LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17605-0396
Mailing Address - Country:US
Mailing Address - Phone:717-291-1313
Mailing Address - Fax:717-735-8351
Practice Address - Street 1:1858 CHARTER LN
Practice Address - Street 2:SUITE 202
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17605-0396
Practice Address - Country:US
Practice Address - Phone:717-291-1313
Practice Address - Fax:717-291-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39D0657394291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA152583Medicare ID - Type Unspecified