MEDICARE: MR. JAMES ANDREW EGNOR 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	MA 001425L	PA

General Provider Information

NPI Number	:	1770556524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES ANDREW EGNOR PA C

Provider Business Mailing Address
First Line	:	831 PROVIDENCE RD
Second Line	:
City	:	SECANE
State	:	PA
Zip	:	19018-2921
Country	:	US
Telephone Number	:	610-394-1234
Fax Number	:	610-284-4811

Provider Business Practice Location Address
First Line	:	925 PROVIDENCE RD STE 8/9
Second Line	:
City	:	SECANE
State	:	PA
Zip	:	19018-2920
Country	:	US
Telephone Number	:	610-394-1234
Fax Number	:	610-284-4811

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	05/25/2021

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Directions to “ MR. JAMES ANDREW EGNOR PA C” Practice Location

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