Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

The Pennsylvania State University

Organization Orthopaedic Surgery Physician · NPI 1861949869

The Pennsylvania State University is an Orthopaedic Surgery Physician in University Park, Pennsylvania. Licensed in Pennsylvania. Registered with an NPI since 2016.

Licensed in
PA
In the registry since
2016

Practice location Address checks out

408 Old Main
University Park, PA 16802-1505
Phone: (814) 865-4700
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Orthopaedic Surgery Physician (primary) Taxonomy 207X00000X · Licence MD062970L (PA)

Record details

NPI number1861949869
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mouzon Bass — Agent · (972) 367-4845
Other names Pennsylvania State University Sports Medicine
NPI enumeratedSeptember 7, 2016
Last updated in NPPESFebruary 27, 2024
Certification dateFebruary 27, 2024
Mailing address5050 Spring Valley Rd., Dallas, TX 75244-3909