Provider Demographics
NPI:1114300514
Name:BIFOLCK, DANA SHELBY (PA-C)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:SHELBY
Last Name:BIFOLCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:BERGSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1021 MAIN ST
Mailing Address - Street 2:STE 203
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1970
Mailing Address - Country:US
Mailing Address - Phone:781-756-2118
Mailing Address - Fax:781-756-7274
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-6946
Practice Address - Country:US
Practice Address - Phone:336-716-9997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7310363A00000X
NC0010-05774363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant