Provider Demographics
NPI:1417049628
Name:DENZINE, MEREDITH ANN I (PA-C)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANN
Last Name:DENZINE
Suffix:I
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 1:919 CONESTOGA RD
Mailing Address - Street 2:BUILDING 2, SUITE 106
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1352
Mailing Address - Country:US
Mailing Address - Phone:610-525-5028
Mailing Address - Fax:610-525-2494
Practice Address - Street 1:919 CONESTOGA RD
Practice Address - Street 2:BUILDING 2, SUITE 106
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1352
Practice Address - Country:US
Practice Address - Phone:610-525-5028
Practice Address - Fax:610-525-2494
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002286363A00000X
MDC0003154363AM0700X
PAMA053509363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q58878Medicare UPIN