Provider Demographics
NPI:1053774257
Name:DUFFY, ALEXANDER CHRISTIAN (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:CHRISTIAN
Last Name:DUFFY
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 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:689 YORKTOWN RD
Practice Address - Street 2:
Practice Address - City:LEWISBERRY
Practice Address - State:PA
Practice Address - Zip Code:17339-9258
Practice Address - Country:US
Practice Address - Phone:717-932-4050
Practice Address - Fax:717-932-8072
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
PAOA003819363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA524671F6KOtherMEDICARE
PA1032099520001Medicaid