Healthcare Provider Details

I. General information

NPI: 1851329163
Provider Name (Legal Business Name): MELISSA JANE GAMMIE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 4TH ST
EAST BERLIN PA
17316-9638
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-4900
  • Fax: 717-259-7262
Mailing address:
  • Phone: 717-812-4900
  • Fax: 717-259-7262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA001891L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA001891L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: