Healthcare Provider Details

I. General information

NPI: 1043981046
Provider Name (Legal Business Name): BRIDGET O'REILLY EGAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N LANSDOWNE AVE
DREXEL HILL PA
19026-1114
US

IV. Provider business mailing address

8 WILLOWBROOK RD
BROOMALL PA
19008-1746
US

V. Phone/Fax

Practice location:
  • Phone: 610-284-8100
  • Fax:
Mailing address:
  • Phone: 610-755-7907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062979
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA062979
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: