MEDICARE: ANDREA M BOLESTA 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	363AM0700X	Medical Physician Assistant	25MP00265400	NJ
2	363A00000X	Physician Assistant	MA055091	PA

General Provider Information

NPI Number	:	1467733816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA M BOLESTA PA-C

Provider Business Mailing Address
First Line	:	1296 GROVE RD
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-1062
Country	:	US
Telephone Number	:	610-585-0192
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 ARRANDALE BLVD
Second Line	:
City	:	EXTON
State	:	PA
Zip	:	19341-2503
Country	:	US
Telephone Number	:	610-363-2532
Fax Number	:

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

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	01/05/2023

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Directions to “ ANDREA M BOLESTA PA-C” Practice Location

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