Provider Demographics
NPI:1942353289
Name:BARTHOLOMEW, LARRY D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:D
Last Name:BARTHOLOMEW
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 1:30 TYLER DR
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17963-8050
Mailing Address - Country:US
Mailing Address - Phone:717-861-9175
Mailing Address - Fax:717-861-8235
Practice Address - Street 1:30 TYLER DR
Practice Address - Street 2:
Practice Address - City:PINE GROVE
Practice Address - State:PA
Practice Address - Zip Code:17963-8050
Practice Address - Country:US
Practice Address - Phone:570-345-3254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000051L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant