MEDICARE: MR. BRUCE W. BODY 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	52766	CA
2	363A00000X	Physician Assistant	MA002013L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	106930	OTHER	PA	MEDICARE

General Provider Information

NPI Number	:	1467430942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE W. BODY PA-C

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1824 EAST THIRD ST.
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-6063
Country	:	US
Telephone Number	:	570-601-2200
Fax Number	:	570-601-2202

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	08/30/2020

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Directions to “ MR. BRUCE W. BODY PA-C” Practice Location

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