Provider Demographics
NPI:1063954501
Name:CZEKAI, KELSEY (PA-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:CZEKAI
Suffix:
Gender:F
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 1:116 S GEORGE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401-1443
Mailing Address - Country:US
Mailing Address - Phone:717-801-4821
Mailing Address - Fax:717-854-0377
Practice Address - Street 1:369 LOCUST STREET
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512
Practice Address - Country:US
Practice Address - Phone:717-342-2577
Practice Address - Fax:717-449-5082
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003971207Q00000X
PAMA058449363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C31433Medicare UPIN