Provider Demographics
NPI:1629677356
Name:TAKACS, JASON CHRISTOPHER JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:TAKACS
Suffix:JR
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 1:7500 BROOKTREE RD STE 302
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9285
Mailing Address - Country:US
Mailing Address - Phone:866-874-7483
Mailing Address - Fax:
Practice Address - Street 1:7500 BROOKTREE RD STE 302
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9285
Practice Address - Country:US
Practice Address - Phone:866-874-7483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005536363AM0700X
PAMA061959363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical