MEDICARE: MASON ANDREW HARTZLER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.006003RX	OH

General Provider Information

NPI Number	:	1184285645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASON ANDREW HARTZLER PA-C

Provider Business Mailing Address
First Line	:	8586 BENNER RD
Second Line	:
City	:	MARSHALLVILLE
State	:	OH
Zip	:	44645-9310
Country	:	US
Telephone Number	:	330-439-3112
Fax Number	:

Provider Business Practice Location Address
First Line	:	3378 W MARKET ST
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-3306
Country	:	US
Telephone Number	:	330-576-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	01/04/2020

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