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General NPI Number Information
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NPI Number | 1619799541
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Entity Type | Individual
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Provider Name | MIA GENERA FORTE PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 4755 OGLETOWN STANTON RD
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City | NEWARK
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State | DE
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Zip | 19718-2200
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Country | US
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Telephone | 302-733-6510
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Fax | 302-733-3340
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Provider Business Mailing Address
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Address Line | 8096 HERITAGE DR
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City | ALBURTIS
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State | PA
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Zip | 18011-2714
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Country | US
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Telephone | 610-554-6013
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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 | C5-0012201
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA066138
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License Number State | PA
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