Provider Demographics
NPI:1669785309
Name:FOWLER, JASON M (PA-C)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:FOWLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-2875
Mailing Address - Fax:717-334-3921
Practice Address - Street 1:455 S WASHINGTON ST STE 12
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2516
Practice Address - Country:US
Practice Address - Phone:717-339-2875
Practice Address - Fax:717-334-3921
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054391363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
12238641OtherCAQH
PA464560FLTMedicare PIN
12238641OtherCAQH