Provider Demographics
NPI:1851161517
Name:SCHROECK, ALEX JOHN (PA-C)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:JOHN
Last Name:SCHROECK
Suffix:
Gender:
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 1:2315 MYRTLE ST STE 190
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4604
Mailing Address - Country:US
Mailing Address - Phone:814-453-7767
Mailing Address - Fax:814-454-6667
Practice Address - Street 1:2315 MYRTLE ST STE 190
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4604
Practice Address - Country:US
Practice Address - Phone:814-453-7767
Practice Address - Fax:814-454-6667
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMA066430363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program