Provider Demographics
NPI:1083991814
Name:SCHIMP, MARY C (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:SCHIMP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1404 BALTIMORE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-8698
Mailing Address - Country:US
Mailing Address - Phone:717-637-0470
Mailing Address - Fax:717-637-4987
Practice Address - Street 1:416 N BROAD ST
Practice Address - Street 2:
Practice Address - City:EMPORIUM
Practice Address - State:PA
Practice Address - Zip Code:15834-1402
Practice Address - Country:US
Practice Address - Phone:814-486-2202
Practice Address - Fax:814-788-4616
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055195363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232075Medicare PIN