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NPI Code Detail

MEDICARE: MARY ELIZABETH REESE PA-C

MEDICARE: MARY ELIZABETH REESE 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
1363AM0700XMedical Physician AssistantMA000413LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
150055176OTHERPACAPITAL BLUE CROSS

General Provider Information

NPI Number : 1811951395
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELIZABETH REESE PA-C
Provider Business Mailing Address
First Line : PO BOX 251
Second Line :
City : BOALSBURG
State : PA
Zip : 16827-0251
Country : US
Telephone Number : 814-235-3051
Fax Number : 814-359-5629
Provider Business Practice Location Address
First Line : 550 W COLLEGE AVE
Second Line :
City : PLEASANT GAP
State : PA
Zip : 16823-7401
Country : US
Telephone Number : 814-359-5620
Fax Number : 814-359-5629
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2006
Last Update Date : 07/15/2013

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