Provider Demographics
NPI:1083613590
Name:DECAWSKI, PATRICIA (PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DECAWSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 BETHLEHEM PIKE
Mailing Address - Street 2:60-176
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477-1102
Mailing Address - Country:US
Mailing Address - Phone:302-294-2555
Mailing Address - Fax:425-669-1611
Practice Address - Street 1:1121 BETHLEHEM PIKE
Practice Address - Street 2:60-176
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-1102
Practice Address - Country:US
Practice Address - Phone:302-294-2555
Practice Address - Fax:425-669-1611
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001730L363AM0700X
DEC5-0000567363AM0700X
MDC0003719363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R83222Medicare UPIN
R832226072Medicare ID - Type Unspecified