Provider Demographics
NPI:1285856716
Name:MERMAGEN, JILL RACHEL (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:RACHEL
Last Name:MERMAGEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 GREEN SPRING ROAD
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRAACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-1111
Mailing Address - Country:US
Mailing Address - Phone:410-734-4039
Mailing Address - Fax:
Practice Address - Street 1:4755 STANTON OGLETOWN ROAD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-733-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical