MEDICARE: KYLE PANE PA

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	022334	NY
2	363A00000X	Physician Assistant	MA061510	PA

General Provider Information

NPI Number	:	1851874549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE PANE PA

Provider Business Mailing Address
First Line	:	111 ROUTE 715 STE 100
Second Line	:
City	:	BRODHEADSVILLE
State	:	PA
Zip	:	18322-7101
Country	:	US
Telephone Number	:	272-212-0426
Fax Number	:	607-729-3982

Provider Business Practice Location Address
First Line	:	111 ROUTE 715 STE 100
Second Line	:
City	:	BRODHEADSVILLE
State	:	PA
Zip	:	18322-7101
Country	:	US
Telephone Number	:	272-212-0426
Fax Number	:	607-729-3982

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

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	06/19/2023

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Directions to “ KYLE PANE PA” Practice Location

Language	Start Address	Practice Location

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