Basic Information
| Provider Information | |||||||||
| NPI: | 1972052298 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KATOS | ||||||||
| FirstName: | ALEXANDRE | ||||||||
| MiddleName: | MYLES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1635 W MAIN ST | ||||||||
| Address2: | STE 700 | ||||||||
| City: | EPHRATA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175228822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177380660 | ||||||||
| FaxNumber: | 7177380658 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 W AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | LITITZ | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175439274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7174662445 | ||||||||
| FaxNumber: | 7174662447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2016 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA058588 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | OA003914 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.