Provider Demographics
NPI:1275082307
Name:NEEDHAM, MORGAN E (PA-C)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:E
Last Name:NEEDHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:E
Other - Last Name:BONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1230 S CEDAR CREST BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6212
Mailing Address - Country:US
Mailing Address - Phone:610-432-4529
Mailing Address - Fax:610-432-2206
Practice Address - Street 1:1230 S CEDAR CREST BLVD STES 301, 302, 304
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6212
Practice Address - Country:US
Practice Address - Phone:610-432-4529
Practice Address - Fax:610-432-2206
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003924363A00000X
PAMA058589363A00000X
NJ25MP00461200363A00000X, 363AM0700X
PAMA058689363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant