MEDICARE: MR. ALEXANDER V. MEZENTSEV 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	MA054663	PA

General Provider Information

NPI Number	:	1780988766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEXANDER V. MEZENTSEV PA-C

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

Provider Business Practice Location Address
First Line	:	255 ROUTE 220 HWY
Second Line	:
City	:	MUNCY
State	:	PA
Zip	:	17756-7568
Country	:	US
Telephone Number	:	800-230-4565
Fax Number	:

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

Provider Enumeration Date	:	01/05/2011
Last Update Date	:	03/28/2025

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