Provider Demographics
NPI:1760636591
Name:HOSTETTER, RODNEY D (PA-C)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:D
Last Name:HOSTETTER
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 1:2118 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2427
Mailing Address - Country:US
Mailing Address - Phone:717-544-0150
Mailing Address - Fax:717-544-0151
Practice Address - Street 1:2118 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2427
Practice Address - Country:US
Practice Address - Phone:717-544-0150
Practice Address - Fax:717-544-0151
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053029363AM0700X
MDC0008944363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA235508Medicare PIN