Provider Demographics
NPI:1629187612
Name:CEVASCO, MICHAEL ALAN (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALAN
Last Name:CEVASCO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:3210 HARMONY HWY
Mailing Address - City:HARMONY
Mailing Address - State:NC
Mailing Address - Zip Code:28634-0128
Mailing Address - Country:US
Mailing Address - Phone:704-546-7587
Mailing Address - Fax:
Practice Address - Street 1:3210 HARMONY HWY
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:NC
Practice Address - Zip Code:28634-0128
Practice Address - Country:US
Practice Address - Phone:704-546-7587
Practice Address - Fax:704-546-7660
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC101535363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
3103653OtherMAMSI
NC014UTOtherBCBS
C6567OtherMEDCOST
NC343919Medicare Oscar/Certification
NCP60430Medicare UPIN