MEDICARE: JACQUELYN MENARDE PA-C

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	363AM0700X	Medical Physician Assistant	MA057211	PA

General Provider Information

NPI Number	:	1568864817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN MENARDE PA-C

Provider Business Mailing Address
First Line	:	649 N LEWIS RD
Second Line	:	SUITE 225
City	:	ROYERSFORD
State	:	PA
Zip	:	19468-1234
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	649 N LEWIS RD
Second Line	:	SUITE 225
City	:	ROYERSFORD
State	:	PA
Zip	:	19468-1234
Country	:	US
Telephone Number	:	610-495-3620
Fax Number	:

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

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	09/18/2014

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Directions to “ JACQUELYN MENARDE PA-C” Practice Location

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