Healthcare Provider Details

I. General information

NPI: 1669470738
Provider Name (Legal Business Name): AMY BETH WERTMAN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 CONESTOGA ROAD BUILDING ONE SUITE #300
BRYN MAWR PA
19010-1352
US

IV. Provider business mailing address

919 CONESTOGA ROAD BUILDING ONE SUITE #300
BRYN MAWR PA
19010-1352
US

V. Phone/Fax

Practice location:
  • Phone: 610-525-6580
  • Fax: 610-525-3664
Mailing address:
  • Phone: 610-525-6580
  • Fax: 610-525-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA003367L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: