MEDICARE: CHRISTINE EMILY DEANDREA MPAS PA-C

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	363A00000X	Physician Assistant	MA061507	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA061507	OTHER	PA	PENNSYLVANIA STATE DEPARTMENT OF MEDICINE, PHYSICIAN ASSISTANT L

General Provider Information

NPI Number	:	1821627209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE EMILY DEANDREA MPAS PA-C

Provider Business Mailing Address
First Line	:	2591 WILDWOOD RD
Second Line	:
City	:	ALLISON PARK
State	:	PA
Zip	:	15101-2223
Country	:	US
Telephone Number	:	412-303-3893
Fax Number	:

Provider Business Practice Location Address
First Line	:	2575 BOYCE PLAZA RD
Second Line	:
City	:	UPPER ST CLAIR
State	:	PA
Zip	:	15241-3994
Country	:	US
Telephone Number	:	412-257-2290
Fax Number	:

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

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	04/07/2020

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