Healthcare Provider Details

I. General information

NPI: 1790653756
Provider Name (Legal Business Name): ANGEL ESCOBAR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SCHOOLHOUSE RD
MIDDLETOWN PA
17057-3548
US

IV. Provider business mailing address

1619 WAGONWHEEL RD
WIMAUMA FL
33598-7830
US

V. Phone/Fax

Practice location:
  • Phone: 717-948-5180
  • Fax:
Mailing address:
  • Phone: 619-204-1571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA067037
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: