Provider Demographics
NPI:1194719260
Name:THOMAS, JASON (PA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EXCELA HEALTH DR STE 202
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-9001
Mailing Address - Country:US
Mailing Address - Phone:724-532-5360
Mailing Address - Fax:724-879-4033
Practice Address - Street 1:100 EXCELA HEALTH DR STE 202
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-9001
Practice Address - Country:US
Practice Address - Phone:724-532-5360
Practice Address - Fax:724-879-4033
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051712363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA321118Medicare PIN