Provider Demographics
NPI:1376511295
Name:MUSCARELLA, JENNIFER M (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MUSCARELLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-375-3043
Mailing Address - Fax:330-375-7932
Practice Address - Street 1:525 E MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1619
Practice Address - Country:US
Practice Address - Phone:330-375-3043
Practice Address - Fax:330-375-7932
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010664-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1376511295OtherUNIVERA HEALTHCARE
NYQ56302Medicare UPIN
NY9515380OtherINDEPENDENT HEALTH
NYP00658340OtherRAILROAD MEDICARE
NYPA1101Medicare PIN
NY173597OtherPREFERRED CARE OF NY
NY060103000051OtherFIDELIS OF NY
NY000570557002OtherBCBS OF WESTERN NY
NY02712825Medicaid