MEDICARE: DEREK FLYNN P.A.

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	MA053575	PA

General Provider Information

NPI Number	:	1619970936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK FLYNN P.A.

Provider Business Mailing Address
First Line	:	PO BOX 858
Second Line	:	MCA410
City	:	HERSHEY
State	:	PA
Zip	:	17033-0858
Country	:	US
Telephone Number	:	717-531-1507
Fax Number	:	717-531-0385

Provider Business Practice Location Address
First Line	:	30 HOPE DR
Second Line	:
City	:	HERSHEY
State	:	PA
Zip	:	17033-2036
Country	:	US
Telephone Number	:	800-243-1455
Fax Number	:

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	03/15/2012

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