Provider Demographics
NPI:1427028034
Name:BLOSSER, LARA H (PA-C)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:H
Last Name:BLOSSER
Suffix:
Gender:F
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 1:508 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1702
Mailing Address - Country:US
Mailing Address - Phone:724-547-1500
Mailing Address - Fax:
Practice Address - Street 1:508 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1702
Practice Address - Country:US
Practice Address - Phone:724-547-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051424363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ05969Medicare UPIN
PA087925Medicare ID - Type Unspecified