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General NPI Number Information
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NPI Number | 1740787423
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Entity Type | Individual
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Provider Name | THERESE A. DONNELLY PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 325 CENTRAL AVE STE 200
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City | MALVERN
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State | PA
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Zip | 19355-3265
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Country | US
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Telephone | 610-644-6755
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Fax |
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Provider Business Mailing Address
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Address Line | 201 N MORGAN AVE
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City | HAVERTOWN
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State | PA
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Zip | 19083-5009
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Country | US
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Telephone | 610-955-5338
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA059740
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License Number State | PA
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