Provider Demographics
NPI:1972052298
Name:KATOS, ALEXANDRE MYLES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDRE
Middle Name:MYLES
Last Name:KATOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1635 W MAIN ST
Mailing Address - Street 2:STE 700
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-8822
Mailing Address - Country:US
Mailing Address - Phone:717-738-0660
Mailing Address - Fax:717-738-0658
Practice Address - Street 1:101 W AIRPORT RD
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9274
Practice Address - Country:US
Practice Address - Phone:717-466-2445
Practice Address - Fax:717-466-2447
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058588363A00000X
PAOA003914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant