Provider Demographics
NPI:1972865095
Name:ACHENBACH, AMANDA M (PAC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:ACHENBACH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-4005
Mailing Address - Fax:717-812-2495
Practice Address - Street 1:55 MONUMENT RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5023
Practice Address - Country:US
Practice Address - Phone:717-851-4005
Practice Address - Fax:717-812-2495
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055541363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1610304OtherGATEWAY MEDICARE ASSURED
PAP01152137Medicare PIN
PA243295FLTMedicare PIN