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General NPI Number Information
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NPI Number | 1124938378
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Entity Type | Individual
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Provider Name | MARISSA PENA
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Gender | Female
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 255 WEST LANCASTER AVENUE MEDICAL OFFICE BUILDING 3, SUITE 237
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City | PAOLI
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State | PA
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Zip | 19301
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Country | US
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Telephone | 484-565-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 715 LEHANN CIR
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City | SPRINGFIELD
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State | PA
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Zip | 19064-3526
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA067899
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License Number State | PA
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