Provider Demographics
NPI:1184665234
Name:DISCAVAGE, MICHAEL L (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:DISCAVAGE
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 1:625 S DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-4509
Mailing Address - Country:US
Mailing Address - Phone:717-299-6371
Mailing Address - Fax:717-397-8881
Practice Address - Street 1:625 S DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-4509
Practice Address - Country:US
Practice Address - Phone:717-299-6371
Practice Address - Fax:717-397-8881
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001396L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
038587FDDMedicare ID - Type Unspecified
PAP08427Medicare UPIN