Healthcare Provider Details

I. General information

NPI: 1457036469
Provider Name (Legal Business Name): ALLISON MORGAN BEAVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 PARK DR
PALMYRA PA
17078-3404
US

IV. Provider business mailing address

248 JAMISON RD
MC ALISTERVILLE PA
17049-8589
US

V. Phone/Fax

Practice location:
  • Phone: 717-838-6305
  • Fax: 717-838-5332
Mailing address:
  • Phone: 717-979-3044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNA
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: