Healthcare Provider Details

I. General information

NPI: 1669451779
Provider Name (Legal Business Name): THOMAS G SCOUFALOS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 01/30/2021
Certification Date: 01/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 SOUTHFIELD DR
YORK PA
17403-4510
US

IV. Provider business mailing address

2690 SOUTHFIELD DR
YORK PA
17403-4510
US

V. Phone/Fax

Practice location:
  • Phone: 717-741-1414
  • Fax: 717-741-4774
Mailing address:
  • Phone: 717-741-1414
  • Fax: 717-741-4774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA050727
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: