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NPI Code Detail

MEDICARE: BARBARA PROTENIC PAC

MEDICARE: BARBARA PROTENIC PAC
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
1363AM0700XMedical Physician AssistantMA000404LPA

General Provider Information

NPI Number : 1710029335
Entity Type Code : Individual
Provider Name (Legal Business Name) : BARBARA PROTENIC PAC
Provider Business Mailing Address
First Line : 1600 BLACK ROCK RD
Second Line :
City : ROYERSFORD
State : PA
Zip : 19468-3109
Country : US
Telephone Number : 610-792-2224
Fax Number : 610-792-4026
Provider Business Practice Location Address
First Line : 1600 BLACK ROCK RD
Second Line :
City : ROYERSFORD
State : PA
Zip : 19468-3109
Country : US
Telephone Number : 610-792-2224
Fax Number : 610-792-4026
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 07/09/2007

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Directions to “ BARBARA PROTENIC PAC” Practice Location

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