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General NPI Number Information
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NPI Number | 1821266016
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Entity Type | Individual
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Provider Name | MELISSA CARRASQUILLO PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 1025 WALNUT ST. SUITE 726
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5001
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Country | US
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Telephone | 215-955-1648
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 191
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City | ROCKLAND
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State | DE
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Zip | 19723-0191
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Country | US
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Telephone | 302-651-4000
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Fax | 302-651-4945
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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 | MA053286
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License Number State | PA
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