MEDICARE: HOLLY ELIZABETH SKALA 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	OA000239L	PA
2	363A00000X	Physician Assistant	MA002032L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970023783	OTHER	PA	RAILROAD MEDICARE IND#

General Provider Information

NPI Number	:	1790780245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY ELIZABETH SKALA PA-C

Provider Business Mailing Address
First Line	:	2500 W 12TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-4508
Country	:	US
Telephone Number	:	814-838-9000
Fax Number	:	814-838-0462

Provider Business Practice Location Address
First Line	:	2500 W 12TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-4508
Country	:	US
Telephone Number	:	814-838-9000
Fax Number	:	814-838-0462

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/29/2014

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