Provider Demographics
NPI:1457597635
Name:HAUGH, AMANDA D (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:HAUGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:D
Other - Last Name:HEIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:205 SAINT CHARLES WAY
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4659
Mailing Address - Country:US
Mailing Address - Phone:717-741-4666
Mailing Address - Fax:717-741-0538
Practice Address - Street 1:205 SAINT CHARLES WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4659
Practice Address - Country:US
Practice Address - Phone:717-741-4666
Practice Address - Fax:717-741-0538
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053743363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant