Provider Demographics
NPI:1164590733
Name:DECANIO, JANET VOLTAGGIO (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:VOLTAGGIO
Last Name:DECANIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JANET
Other - Middle Name:MARIE
Other - Last Name:VOLTAGGIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
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:717-261-0929
Mailing Address - Fax:717-261-0902
Practice Address - Street 1:1610 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-9206
Practice Address - Country:US
Practice Address - Phone:717-261-0929
Practice Address - Fax:717-260-0902
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001724363A00000X
PAMA053075363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0034493000Medicaid
PA867633OtherMEDICARE GROUP #
VA0110001724OtherLICENSE
PAMA053075OtherLICENSE
WV001714410Medicaid
PAMD1671432OtherDEA
WV0034493000Medicaid