Provider Demographics
NPI:1699064451
Name:ALCANTARA, JASON (MHS, PA-C)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ALCANTARA
Suffix:
Gender:M
Credentials:MHS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 233
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:484-458-1000
Mailing Address - Fax:610-642-2036
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 233
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-458-1000
Practice Address - Fax:610-642-2036
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054838363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA211685Q7RMedicare PIN