Provider Demographics
NPI:1700256260
Name:CLAUSS, MICAH
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:CLAUSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 HARRISBURG PIKE STE 202
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-869-4600
Mailing Address - Fax:717-544-3501
Practice Address - Street 1:2112 HARRISBURG PIKE STE 202
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-869-4600
Practice Address - Fax:717-544-3501
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059512363AM0700X
LAPA.200888363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2411080Medicaid
PA1033898600052Medicaid
PA627260KKUOtherMEDICARE
PA1033898600053Medicaid
PAMA059512OtherLICENSE
PAMC4619954OtherDEA