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Individual
TROY A LANDES
Active
Individual
TROY A LANDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA050718
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007307260034
MEDICARE GROUP #
PA
01
—
120420414
DEPT OF LABOR
PA
01
—
25-1716306
INTERGROUP
PA
01
—
498815
HEALTH AMERICA
PA
01
—
50064072
CAPITAL BLUECROSS
PA
01
—
MA050718
LICENSE
PA
Enumeration date
03/01/2006
Last updated
03/07/2023
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