MEDICARE: MR. CASEY TRAVIS RYAN PAC

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	0010-00045	NC
2	363AM0700X	Medical Physician Assistant	MA052476	PA

General Provider Information

NPI Number	:	1912982638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CASEY TRAVIS RYAN PAC

Provider Business Mailing Address
First Line	:	3421 CONCORD RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-9001
Country	:	US
Telephone Number	:	717-851-2441
Fax Number	:	717-260-3322

Provider Business Practice Location Address
First Line	:	30 MONUMENT RD
Second Line	:	SUITE 1100
City	:	YORK
State	:	PA
Zip	:	17403-5024
Country	:	US
Telephone Number	:	717-851-2441
Fax Number	:	717-260-3322

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	09/23/2022

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