Provider Demographics
NPI:1609249127
Name:LANCASTER, JARED (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:
Last Name:LANCASTER
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 KENT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3794
Mailing Address - Country:US
Mailing Address - Phone:301-777-2503
Mailing Address - Fax:
Practice Address - Street 1:625 KENT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3794
Practice Address - Country:US
Practice Address - Phone:301-777-2503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05992363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical