Provider Demographics
NPI:1609870203
Name:AUTEN, GARTH E (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GARTH
Middle Name:E
Last Name:AUTEN
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 1:475 N WEABER ST
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-1104
Mailing Address - Country:US
Mailing Address - Phone:717-867-4671
Mailing Address - Fax:717-867-2418
Practice Address - Street 1:475 N WEABER ST
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-1104
Practice Address - Country:US
Practice Address - Phone:717-867-4671
Practice Address - Fax:717-867-2418
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAQA000393L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA077571Medicare ID - Type Unspecified
PAS69300Medicare UPIN