Matthew Steven Stake, PA-C
Physician Assistant in Hanover, PA. Individual provider (NPI-1).
NPI number1982190377
StatusActive
Last updated in NPPESOct 3, 2022
Details
- NPI
- 1982190377
- Entity type
- Individual (NPI-1)
- Name
- Matthew Steven Stake
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 9, 2018
- Certification date
- Oct 3, 2022
- Last updated
- Oct 3, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | OA004494 | PA | Yes |
| 363AM0700X | Physician Assistant, Medical | MA059828 | PA | |
| 363AM0700X | Physician Assistant, Medical | OA004494 | PA | |
| 363A00000X | Physician Assistant | MA059828 | PA |
Practice location
250 Fame Ave Ste 206-AHanover, PA 17331-1587
Phone 717-316-2248
Mailing address
16837 Roosevelt LnShrewsbury, PA 17361-1625
Phone 717-576-5162
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