Healthcare Provider Details

I. General information

NPI: 1467857326
Provider Name (Legal Business Name): KEVIN DELLA ROSA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST PRISCILLA PAYNE HURD PAVILION, 2ND FLOOR
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-1735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA057277
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: