MEDICARE: MISS ABBE MICHELE CLYDE 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	018655	NY
2	363A00000X	Physician Assistant	C5-0000831	DE
3	363A00000X	Physician Assistant	MA061783	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841547239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ABBE MICHELE CLYDE PA-C

Provider Business Mailing Address
First Line	:	606 COMMUNITY WAY
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603-2329
Country	:	US
Telephone Number	:	610-687-8771
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 COMMUNITY WAY
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603-2329
Country	:	US
Telephone Number	:	610-687-8771
Fax Number	:

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

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	06/07/2022

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