MEDICARE: ANDREA BEVIN MIRTH 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	MA051453	PA

General Provider Information

NPI Number	:	1477551729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA BEVIN MIRTH PA-C

Provider Business Mailing Address
First Line	:	3580 PEACH ST STE 100
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16508-2776
Country	:	US
Telephone Number	:	814-877-8750
Fax Number	:	814-866-1436

Provider Business Practice Location Address
First Line	:	3580 PEACH ST STE 100
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16508-2776
Country	:	US
Telephone Number	:	814-877-8750
Fax Number	:	814-866-1436

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	02/01/2023

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