Healthcare Provider Details

I. General information

NPI: 1205757697
Provider Name (Legal Business Name): BLYTHE MCCARRON MALANDRINO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3945 CHESTNUT ST APT 407
PHILADELPHIA PA
19104-3626
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-4000
  • Fax:
Mailing address:
  • Phone: 408-709-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA067929
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: