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NPI Code Detail

MEDICARE: JAIME PEDRAZA P.A.

MEDICARE:   JAIME  PEDRAZA  P.A.
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 AssistantPA2779FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MA-002409-LOTHERPAPENNSYLVANIA LICENCE
2PA2779OTHERFLMEDICAL LICENSE

General Provider Information

NPI Number : 1790774297
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAIME PEDRAZA P.A.
Provider Business Mailing Address
First Line : 1 MEDICAL CENTER BLVD
Second Line :
City : CHESTER
State : PA
Zip : 19013-3902
Country : US
Telephone Number : 610-619-7360
Fax Number : 610-619-7366
Provider Business Practice Location Address
First Line : 30 MEDICAL CENTER BLVD BLDG 1
Second Line :
City : CHESTER
State : PA
Zip : 19013-3955
Country : US
Telephone Number : 610-874-6448
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 01/15/2019

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