Healthcare Provider Details

I. General information

NPI: 1821555251
Provider Name (Legal Business Name): ALEXANDER JAMES TAYLOR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEX TAYLOR PA-C

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 POPLAR CHURCH RD STE 210
CAMP HILL PA
17011-2250
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-761-7244
  • Fax: 717-761-2055
Mailing address:
  • Phone: 717-851-2465
  • Fax: 717-741-3043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060384
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA060384
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA060384
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: