Provider Demographics
NPI:1992530380
Name:LANDRY, CONNOR MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:MICHAEL
Last Name:LANDRY
Suffix:
Gender:M
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 1:1175 WALNUT BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-9160
Mailing Address - Country:US
Mailing Address - Phone:717-258-9355
Mailing Address - Fax:
Practice Address - Street 1:1175 WALNUT BOTTOM RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-9160
Practice Address - Country:US
Practice Address - Phone:717-258-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA006989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant