Provider Demographics
NPI:1295068229
Name:ROY, ALEXANDER SETH IV (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:SETH
Last Name:ROY
Suffix:IV
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:130 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9315
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-522-4120
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9350
Practice Address - Country:US
Practice Address - Phone:570-522-4264
Practice Address - Fax:570-522-4155
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PATMA052149363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant