Provider Demographics
NPI:1386236248
Name:ALBERT, AUSTIN THOMAS (PA)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:THOMAS
Last Name:ALBERT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-0378
Mailing Address - Country:US
Mailing Address - Phone:888-531-7444
Mailing Address - Fax:614-867-9889
Practice Address - Street 1:590 NEWARK GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1436
Practice Address - Country:US
Practice Address - Phone:888-531-7444
Practice Address - Fax:614-867-9889
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006066RX363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant