Provider Demographics
NPI:1841786761
Name:SMOLUK, TAYLOR ROSS (PA-C)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ROSS
Last Name:SMOLUK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:E
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:50 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1440
Mailing Address - Country:US
Mailing Address - Phone:717-234-2561
Mailing Address - Fax:717-236-1121
Practice Address - Street 1:50 N 12TH ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1440
Practice Address - Country:US
Practice Address - Phone:717-234-2561
Practice Address - Fax:717-236-1121
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant