Healthcare Provider Details

I. General information

NPI: 1063404838
Provider Name (Legal Business Name): DARCI L. DELLWARDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DARCI L. BROWN PA-C

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HARRISBURG PIKE STE 5
CARLISLE PA
17015
US

IV. Provider business mailing address

1501 HARRISBURG PIKE STE 5
CARLISLE PA
17015-7306
US

V. Phone/Fax

Practice location:
  • Phone: 717-906-1555
  • Fax: 717-906-1557
Mailing address:
  • Phone: 717-906-1555
  • Fax: 717-906-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA051841
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier50056923
Identifier TypeOTHER
Identifier State
Identifier IssuerCAPITAL BLUE CROSS
# 2
IdentifierP00310849
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 3
Identifier50056923
Identifier TypeOTHER
Identifier State
Identifier IssuerKEYSTONE HEALTH CENTRAL
# 4
Identifier1958621
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: