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NPI Code Detail

MEDICARE: MS. MARY ELLEN S. LARKIN PA -C

MEDICARE: MS. MARY ELLEN S. LARKIN 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
1363A00000XPhysician AssistantMA003393LPA

General Provider Information

NPI Number : 1932139920
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY ELLEN S. LARKIN PA -C
Provider Business Mailing Address
First Line : 901 W ASHLAND AVE
Second Line :
City : GLENOLDEN
State : PA
Zip : 19036-1101
Country : US
Telephone Number : 610-461-6450
Fax Number : 610-461-1842
Provider Business Practice Location Address
First Line : 901 W ASHLAND AVE
Second Line :
City : GLENOLDEN
State : PA
Zip : 19036-1101
Country : US
Telephone Number : 610-461-6450
Fax Number : 610-461-1842
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 03/10/2011

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