Provider Demographics
NPI:1992004873
Name:KROTZER, BETHANY MELISSA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:MELISSA
Last Name:KROTZER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MELISSA
Other - Last Name:RHOADS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-412-7859
Mailing Address - Fax:717-965-3214
Practice Address - Street 1:3301 TRINDLE RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4413
Practice Address - Country:US
Practice Address - Phone:717-412-7859
Practice Address - Fax:717-965-3214
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054727363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103146084Medicaid