Healthcare Provider Details

I. General information

NPI: 1376943662
Provider Name (Legal Business Name): ANDREA MAJCZAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA LOIACANO

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S CEDAR CREST BLVD STE 215
ALLENTOWN PA
18103-6224
US

IV. Provider business mailing address

2100 MACK BLVD 2ND FL
ALLENTOWN PA
18103-5622
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-6986
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA057021
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: