MEDICARE: PATRICIA DECAWSKI P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	MA001730L	PA
2	363AM0700X	Medical Physician Assistant	C5-0000567	DE
3	363AM0700X	Medical Physician Assistant	C0003719	MD

General Provider Information

NPI Number	:	1083613590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA DECAWSKI P.A.

Provider Business Mailing Address
First Line	:	1121 BETHLEHEM PIKE
Second Line	:	60-176
City	:	SPRING HOUSE
State	:	PA
Zip	:	19477-1102
Country	:	US
Telephone Number	:	302-294-2555
Fax Number	:	425-669-1611

Provider Business Practice Location Address
First Line	:	1121 BETHLEHEM PIKE
Second Line	:	60-176
City	:	SPRING HOUSE
State	:	PA
Zip	:	19477-1102
Country	:	US
Telephone Number	:	302-294-2555
Fax Number	:	425-669-1611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	04/26/2012

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