Provider Demographics
NPI:1336278530
Name:MCEWEN, GEOFFREY A (PA-C)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:A
Last Name:MCEWEN
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 1:1335 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1135
Mailing Address - Country:US
Mailing Address - Phone:330-965-4541
Mailing Address - Fax:
Practice Address - Street 1:1335 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1135
Practice Address - Country:US
Practice Address - Phone:330-965-4541
Practice Address - Fax:330-965-4559
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051408363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001941909OtherHIGHMARK BC/BS
PA110100K4RMedicare PIN
PA001941909OtherHIGHMARK BC/BS