Healthcare Provider Details

I. General information

NPI: 1922910728
Provider Name (Legal Business Name): AXEL J GEORGIEFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 INNOVATION DR
YORK PA
17408-8815
US

IV. Provider business mailing address

8746 BLUE BALL RD
STEWARTSTOWN PA
17363-8057
US

V. Phone/Fax

Practice location:
  • Phone: 800-436-4326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: