Healthcare Provider Details

I. General information

NPI: 1922000603
Provider Name (Legal Business Name): JASON A DOS SANTOS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

4043 WATERFORD DR
CENTER VALLEY PA
18034-8692
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-1455
  • Fax:
Mailing address:
  • Phone: 610-476-9270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA051874
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA051874
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2001087
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE SENIOR BLUE
# 2
Identifier50048830
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS
# 3
Identifier2001087
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE CENTRAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: