Provider Demographics
NPI:1073710158
Name:PROBST, AARON ROBERT (PA-C)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:ROBERT
Last Name:PROBST
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:301-797-9240
Mailing Address - Fax:301-797-0008
Practice Address - Street 1:22 ST PAUL DR STE 102
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1036
Practice Address - Country:US
Practice Address - Phone:301-797-9240
Practice Address - Fax:301-797-0008
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC03532363A00000X, 363AM0700X
PAMA053060363AM0700X, 363A00000X
MDT0003532363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00605432OtherRR MEDICARE PIN
MDP00605432OtherRR MEDICARE PIN
PA115137M0TMedicare PIN