Individual
CODY A EZOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
601 E MAIN ST, WAYNESBORO, PA 17268-2332
(717) 765-5088
(717) 765-5066
Mailing address
785 5TH AVE STE 3, CHAMBERSBURG, PA 17201-4232
(717) 263-9555
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA060824
PA
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103650235
—
PA
01
—
14497750
CAQH
—
01
—
MA060824
PA LICENSE
PA
Enumeration date
07/03/2019
Last updated
05/12/2022
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