Basic Information
Provider Information
NPI: 1184854770
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PAROS
FirstName: ELIZABETH
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: PAROSMCANENY
OtherFirstName: ELIZABETH
OtherMiddleName: ANN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 1086 FRANKLIN ST
Address2:  
City: JOHNSTOWN
State: PA
PostalCode: 159054305
CountryCode: US
TelephoneNumber: 8144108300
FaxNumber: 8144108331
Practice Location
Address1: 1086 FRANKLIN ST
Address2: BLDG E, STE 3301
City: JOHNSTOWN
State: PA
PostalCode: 159054305
CountryCode: US
TelephoneNumber: 8145345785
FaxNumber: 8145349975
Other Information
ProviderEnumerationDate: 07/17/2009
LastUpdateDate: 05/10/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XMA053936PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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