Provider Demographics
NPI:1265058465
Name:STAHL, ALEX LEE (PA-C)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:LEE
Last Name:STAHL
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 1:131 HICKORY BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:DAVIDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15928-9642
Mailing Address - Country:US
Mailing Address - Phone:814-792-4887
Mailing Address - Fax:
Practice Address - Street 1:321 MAIN ST STE 3C
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1632
Practice Address - Country:US
Practice Address - Phone:814-535-6522
Practice Address - Fax:814-536-4819
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV1173785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant