MEDICARE: DINA SALVERIAN

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	OA004199	PA
2	363A00000X	Physician Assistant	MA059158	PA

General Provider Information

NPI Number	:	1821511668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINA SALVERIAN

Provider Business Mailing Address
First Line	:	PO BOX 745
Second Line	:
City	:	LAHASKA
State	:	PA
Zip	:	18931-0745
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6787 MARKET ST
Second Line	:
City	:	MILLBOURNE
State	:	PA
Zip	:	19082-1848
Country	:	US
Telephone Number	:	610-352-8000
Fax Number	:

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

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	12/21/2017

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Directions to “ DINA SALVERIAN ” Practice Location

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