MEDICARE: MS. BROOKE C. LORAH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA052225	PA
2	363AM0700X	Medical Physician Assistant	MA052225	PA

General Provider Information

NPI Number	:	1255356051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BROOKE C. LORAH PA-C

Provider Business Mailing Address
First Line	:	1034 GROVE ST
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-2945
Country	:	US
Telephone Number	:	814-373-2310
Fax Number	:	814-373-2313

Provider Business Practice Location Address
First Line	:	765 LIBERTY ST STE 105
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-2567
Country	:	US
Telephone Number	:	814-373-2310
Fax Number	:	814-373-2313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	02/19/2025

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