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NPI Code Detail

MEDICARE: MR. DYLAN WILLIAM CORTESE BS, MSPAS, PA-C

MEDICARE: MR. DYLAN WILLIAM CORTESE BS, MSPAS, 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
1363A00000XPhysician Assistant0010-15663NC

General Provider Information

NPI Number : 1942164512
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DYLAN WILLIAM CORTESE BS, MSPAS, PA-C
Provider Business Mailing Address
First Line : 2077 ROSSMORE RD
Second Line :
City : CLEMMONS
State : NC
Zip : 27012-7911
Country : US
Telephone Number : 336-406-5643
Fax Number :
Provider Business Practice Location Address
First Line : 2770 LEWISVILLE CLEMMONS RD
Second Line :
City : CLEMMONS
State : NC
Zip : 27012-8716
Country : US
Telephone Number : 336-766-0324
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2025
Last Update Date : 12/10/2025

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