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NPI Code Detail

MEDICARE: MRS. DONNA M MORTIMER PA

MEDICARE: MRS. DONNA M MORTIMER PA
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
1363AM0700XMedical Physician AssistantMA051640PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MA051640OTHERPAMEDICAL LICENSE NUMBER

General Provider Information

NPI Number : 1841286317
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DONNA M MORTIMER PA
Provider Business Mailing Address
First Line : 12265 TOWNSEND RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19154-1201
Country : US
Telephone Number : 215-856-1010
Fax Number : 215-856-1060
Provider Business Practice Location Address
First Line : 23 BUSTLETON PIKE STE 100
Second Line :
City : FEASTERVILLE TREVOSE
State : PA
Zip : 19053-6446
Country : US
Telephone Number : 215-464-9599
Fax Number : 215-464-7865
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 12/05/2017

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Directions to “ MRS. DONNA M MORTIMER PA” Practice Location

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