Healthcare Provider Details

I. General information

NPI: 1316506918
Provider Name (Legal Business Name): SARAH SURGEONER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MEMORY LANE EXT
YORK PA
17402-9601
US

IV. Provider business mailing address

1500 MEMORY LANE EXT
YORK PA
17402-9601
US

V. Phone/Fax

Practice location:
  • Phone: 717-757-5433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA005448
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA060783
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060783
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: