Provider Demographics
NPI:1275597742
Name:DELAVAN, MARSHA GAY (PA C)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:GAY
Last Name:DELAVAN
Suffix:
Gender:F
Credentials:PA C
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Mailing Address - Street 1:6060 HIGHWAY 165
Mailing Address - Street 2:
Mailing Address - City:RAVENEL
Mailing Address - State:SC
Mailing Address - Zip Code:29470-5407
Mailing Address - Country:US
Mailing Address - Phone:843-889-8982
Mailing Address - Fax:
Practice Address - Street 1:6180 HIGHWAY 162
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:SC
Practice Address - Zip Code:29449-5767
Practice Address - Country:US
Practice Address - Phone:843-889-8018
Practice Address - Fax:843-889-9133
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCMPA319363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S68967Medicare UPIN