Provider Demographics
NPI:1326342544
Name:POPIVCHAK, LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:POPIVCHAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BEIDLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3260 TILLMAN DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2029
Mailing Address - Country:US
Mailing Address - Phone:267-332-0321
Mailing Address - Fax:267-332-0323
Practice Address - Street 1:3260 TILLMAN DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2029
Practice Address - Country:US
Practice Address - Phone:267-332-0321
Practice Address - Fax:267-332-0323
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054776363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA341133ZJB3Medicare PIN