MEDICARE: JAWAIRIA ISLAM 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	MA065303	PA

General Provider Information

NPI Number	:	1215706130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAWAIRIA ISLAM PA-C

Provider Business Mailing Address
First Line	:	4230 CRUMS MILL RD
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-2898
Country	:	US
Telephone Number	:	717-233-6171
Fax Number	:	717-233-7880

Provider Business Practice Location Address
First Line	:	4230 CRUMS MILL RD
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17112-2898
Country	:	US
Telephone Number	:	717-233-6171
Fax Number	:	717-233-7880

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

Provider Enumeration Date	:	12/20/2023
Last Update Date	:	02/02/2026

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Directions to “ JAWAIRIA ISLAM PA-C” Practice Location

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