MEDICARE: BRIDGET THERESA WHITAKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA067280	PA

General Provider Information

NPI Number	:	1538905245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET THERESA WHITAKER

Provider Business Mailing Address
First Line	:	3803 W CHESTER PIKE STE 160
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-2336
Country	:	US
Telephone Number	:	610-642-1908
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E LANCASTER AVE
Second Line	:	SUITE 275 LANKENAU MEDICAL SCI BLD
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-3450
Country	:	US
Telephone Number	:	610-642-1908
Fax Number	:	610-642-6808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	01/21/2026

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