Provider Demographics
NPI:1356338479
Name:WASSEL, MICHAEL J JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:WASSEL
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1259 S CEDAR CREST BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6373
Mailing Address - Country:US
Mailing Address - Phone:610-437-4134
Mailing Address - Fax:610-433-9690
Practice Address - Street 1:1259 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6206
Practice Address - Country:US
Practice Address - Phone:610-437-4134
Practice Address - Fax:610-433-9690
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2023-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA050785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP66506Medicare UPIN
PA172424Medicare ID - Type Unspecified