Provider Demographics
NPI:1114118627
Name:MOREGRASS, CARMELLA DIANE (PHLEBOTOMIST)
Entity Type:Individual
Prefix:MS
First Name:CARMELLA
Middle Name:DIANE
Last Name:MOREGRASS
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 S 56TH STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143
Mailing Address - Country:US
Mailing Address - Phone:215-729-2019
Mailing Address - Fax:215-729-2019
Practice Address - Street 1:1432 S 56TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-4733
Practice Address - Country:US
Practice Address - Phone:215-729-2019
Practice Address - Fax:215-729-2019
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy