MEDICARE: JULIE D LATSHAW

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	363AM0700X	Medical Physician Assistant	MA061486	PA

General Provider Information

NPI Number	:	1427500719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE D LATSHAW

Provider Business Mailing Address
First Line	:	1701 CORNWALL RD
Second Line	:	STE 101
City	:	LEBANON
State	:	PA
Zip	:	17042-7480
Country	:	US
Telephone Number	:	717-544-9400
Fax Number	:	717-544-9401

Provider Business Practice Location Address
First Line	:	2102 HARRISBURG PIKE
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601-2644
Country	:	US
Telephone Number	:	717-544-9400
Fax Number	:	717-544-9401

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

Provider Enumeration Date	:	11/02/2016
Last Update Date	:	12/11/2025

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Directions to “ JULIE D LATSHAW ” Practice Location

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