Provider Demographics
NPI:1861455982
Name:AYLSWORTH, CHRISTOPHER L (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:AYLSWORTH
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 1:1244 W CHESTER PIKE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5657
Mailing Address - Country:US
Mailing Address - Phone:610-738-8016
Mailing Address - Fax:610-918-6316
Practice Address - Street 1:701 E MARSHALL ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4412
Practice Address - Country:US
Practice Address - Phone:610-138-2690
Practice Address - Fax:610-738-2626
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA0098304363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
063220Medicare ID - Type Unspecified
P69367Medicare UPIN