Provider Demographics
NPI:1871555763
Name:MUELLER, JUDITH ANN (PAC)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:MUELLER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:2250 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-2857
Practice Address - Country:US
Practice Address - Phone:717-851-1600
Practice Address - Fax:717-812-5183
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052408363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2044372OtherHIGHMARK BLUE SHIELD
PA50084176OtherCAPITAL BLUE CROSS-WMG WO
PA50077774OtherCAPITAL BLUE CROSS-WMG
PA1568228OtherGAEWAY-WMG
PA970000619Medicare ID - Type Unspecified
PA1568228OtherGAEWAY-WMG
PA129022FLTMedicare PIN