Healthcare Provider Details

I. General information

NPI: 1275610651
Provider Name (Legal Business Name): NORMA CARANDANG-PANIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 E STREET RD SUITE 100
TREVOSE PA
19053-6647
US

IV. Provider business mailing address

4829 E STREET RD SUITE 100
TREVOSE PA
19053-6647
US

V. Phone/Fax

Practice location:
  • Phone: 215-364-5800
  • Fax: 215-364-5899
Mailing address:
  • Phone: 215-364-5800
  • Fax: 215-364-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD044730L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: