Provider Demographics
NPI:1518375435
Name:MISEL, JASON S (PA-C)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:MISEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4218
Practice Address - Street 1:46 WALNUT BOTTOM RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-8219
Practice Address - Country:US
Practice Address - Phone:717-532-4148
Practice Address - Fax:717-532-3561
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057080363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103220252Medicaid
PA867633OtherMEDICARE GROUP #